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HumanaChoice H5525-049 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-049 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-049 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-049 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Eastern North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-049 (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HumanaChoice H5525-049 (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For HumanaChoice H5525-049 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $350.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $14000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $14000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The HumanaChoice H5525-049 (PPO) plan has a $350 deductible for prescription drugs. After meeting the deductible, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you may pay a $5 copay for preferred generic drugs at preferred mail order pharmacies. The plan offers an "Enhanced Alternative" drug benefit. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-049 (PPO) plan provides coverage for a wide range of services. You will have no copay for primary care visits, preventive services, outpatient blood services, and many other services. The plan has copays for inpatient hospital stays, outpatient services, ambulance services, emergency services, specialist visits, hearing exams, and dental services. Additionally, you may have coinsurance for medical equipment, dialysis, and radiological services, so it's important to review the details of these services.
Inpatient Hospital See details
Inpatient Hospital coverage includes Acute and Psychiatric care. For Inpatient Hospital-Acute, you pay a $399 copay for days 1-6, and no copay for days 7-90, with no coinsurance; additional days 91-999 have no copay. Inpatient Hospital Psychiatric has a $399 copay for days 1-5, and no copay for days 6-90, with no coinsurance; additional days and non-Medicare stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $450, and observation services with a $399 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse services have copays ranging from $45 to $100 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-049 (PPO) plan, with an $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
The HumanaChoice H5525-049 (PPO) plan covers both ground and air ambulance services with a $315 copay, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HumanaChoice H5525-049 (PPO) plan. Emergency Services have a $110 copay with no coinsurance, Urgently Needed Services have a $45 copay with no coinsurance, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay with no coinsurance.
Primary Care See details
The HumanaChoice H5525-049 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. The plan also covers physician specialist services with a $35 copay, mental health specialty services with a $45 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $25 copay. Additionally, the plan offers additional telehealth benefits with a copay ranging from $0 to $45, and opioid treatment program services with a copay ranging from $45 to $100.
Preventive Services See details
The HumanaChoice H5525-049 (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered with no copay. However, health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay, and routine hearing exams are covered with no copay for one exam per year. Fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a copay between $699 and $999 for two hearing aids per year. OTC hearing aids are not covered, and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
HumanaChoice H5525-049 (PPO) covers vision services, including eye exams with a copay of $0-$35 and eyewear with no copay. This plan's eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-049 (PPO) covers Medicare dental services with a $35 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. However, fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-049 (PPO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with a 10-20% coinsurance and a $0-$10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and outpatient x-ray services, are covered. Diagnostic procedures/tests have a copay of up to $120, lab services have no copay, diagnostic radiological services have a copay of up to $325, therapeutic radiological services have a coinsurance of at least 20% and a copay of at least $35, and outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5525-049 (PPO) with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
HumanaChoice H5525-049 (PPO) does not cover any Cardiac Rehabilitation Services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-049 (PPO) plan, with a prior authorization requirement. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services include acupuncture, which has a $35 copay and is limited to 20 treatments per year, as well as a meal benefit with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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