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HumanaChoice H5525-050 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-050 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-050 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-050 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-050 (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 H5525-050 (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 H5525-050 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $250.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $13900.00 (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 $13900.00 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 H5525-050 (PPO) Medicare plan has a $350 drug deductible and provides cost-effective options for generic medications. For Tier 1 preferred generics, there is no copay for a one-month or three-month supply at standard pharmacies or through preferred mail order. Tier 2 generics cost a $5 copay for a one-month supply, and you can get a three-month supply with no copay through preferred mail order. For brand-name and higher-tier medications, the plan transitions to higher copays and coinsurance. Tier 3 preferred brand drugs cost a $47 copay for a one-month supply, while Tier 4 non-preferred drugs require a 50% coinsurance. Specialty drugs in Tier 5 require a 29% coinsurance for a one-month supply across standard pharmacies, preferred mail order, and standard mail order.
Additional Benefits
The HumanaChoice H5525-050 (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, annual physical exams, and home health services. For specialist visits, patients pay a $25 copay with no coinsurance, while emergency room visits require a $115 copay that is waived if admitted. Inpatient hospital stays require a $375 daily copay for the first seven days of acute care, with no copay for additional days and no coinsurance overall. This plan also includes valuable supplemental benefits, featuring no copay and no coinsurance for routine hearing and vision exams, alongside a $200 annual allowance for eyewear. Preventive dental care, endodontics, and periodontics are also covered with no copay or coinsurance up to a $1,250 annual limit. Additionally, durable medical equipment is covered with a 16% coinsurance and no copay, while diabetic supplies require a 10% to 20% coinsurance.
Inpatient Hospital See details
HumanaChoice H5525-050 (PPO) covers inpatient hospital care with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays (no copay for days 8 and beyond) and days 1 to 5 of psychiatric stays (no copay for days 6 to 90). This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5525-050 (PPO) with no coinsurance, featuring outpatient hospital copays ranging from $0 to $450 and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the HumanaChoice H5525-050 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5525-050 (PPO) partially covers ambulance and transportation services, offering ground and air ambulance services for a $335 copay and no coinsurance, with prior authorization required. Transportation services are not covered in practice, as transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HumanaChoice H5525-050 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are each covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-050 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $35 copay with no coinsurance, whereas telehealth services have a $0 to $40 copay with no coinsurance. Chiropractic care is partially covered at a $15 copay and no coinsurance, excluding routine and other chiropractic services, while podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice H5525-050 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, fitness benefits, and select screenings. However, several additional services, including health education, nutritional/dietary benefits, and in-home safety assessments, are not covered.
Hearing Services See details
Hearing services are covered by HumanaChoice H5525-050 (PPO) with no deductible, offering one routine exam per year and unlimited fitting evaluations for no copay and no coinsurance, while Medicare-covered exams require a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $199 to $799 for up to two aids per year, excluding inner ear, outer ear, over the ear, and OTC hearing aids.
Vision Services See details
HumanaChoice H5525-050 (PPO) vision services feature no copay, no coinsurance, and no deductible for one routine eye exam and eyewear per year, up to a $200 combined annual limit. While contact lenses and complete eyeglasses are covered, other eye exam services, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5525-050 (PPO) up to a $1,250 annual limit, with no copay and no coinsurance for preventive care, endodontics, periodontics, and oral surgery. Medicare-covered dental services require a $25 copay and no coinsurance, while restorative and prosthodontic services have no copay and 30% to 40% coinsurance; fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-050 (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while covered Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-050 (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5525-050 (PPO) covers medical equipment, including durable medical equipment (DME) at a 16% coinsurance with no copay, and prosthetics and medical supplies at a 20% coinsurance with no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay, with prior authorization required across these categories.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5525-050 (PPO) with no coinsurance for diagnostic services, featuring no copay for lab services and diagnostic test copays ranging from $0 to $120. Outpatient X-rays and diagnostic radiology start at no copay, while therapeutic radiology requires a minimum $25 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice H5525-050 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by HumanaChoice H5525-050 (PPO) with no coinsurance and require prior authorization. Under this plan, cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice H5525-050 (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5525-050 (PPO) partially covers other services, featuring acupuncture for a $25 copay and no coinsurance up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Both covered services require prior authorization, while over-the-counter (OTC) items are not covered.
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