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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 2025, 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 Eastern and Northwest North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-050 (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 $2.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $300.00 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 $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 H5525-050 (PPO) plan has a $350 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $5 copay at a standard pharmacy for a preferred generic drug. For a preferred brand drug, you will pay 50% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H5525-050 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and many preventive services have no copay. The plan also covers emergency services, primary care, hearing, vision, dental, and home health services with varying copays and coinsurance. Ambulance services have a copay, and there is coverage for medical equipment, diagnostic services, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $399 copay for days 1-6, and no copay for days 7-90, and no copay for days 91-999. For Inpatient Hospital Psychiatric, you will pay a $399 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $450, Observation Services with a $399 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $45 and $100 for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-050 (PPO) plan, requiring prior authorization, with an $80 copay.
Ambulance and Transportation Services See details
For HumanaChoice H5525-050 (PPO), ambulance services are covered with a $315 copay for both ground and air ambulance services, and there is no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the HumanaChoice H5525-050 (PPO) plan. You will pay a $110 copay for emergency services, and a $45 copay for urgently needed services, with no coinsurance for either.
Primary Care See details
The HumanaChoice H5525-050 (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay (prior authorization required), and Occupational Therapy Services with a $25 copay. The plan also covers Physician Specialist Services with a $30 copay, and Mental Health Specialty Services with a $45 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $25 copay, and Additional Telehealth Benefits range from no copay to a $45 copay. Opioid Treatment Program Services have a copay between $45 and $100 (prior authorization required). Podiatry Services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered preventive services with no copay, an annual physical exam with no copay, and additional preventive services with varying copays. Other covered services include Kidney Disease Education Services with no copay, Glaucoma Screening with no copay, Diabetes Self-Management Training with no copay, Barium Enemas with no copay, Digital Rectal Exams with no copay, and EKG following Welcome Visit with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, while routine hearing exams are covered with no copay. Fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered with a copay between $499 and $799, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$30, with a maximum plan benefit of $75 every year, while routine eye exams have no copay and are limited to one per year. Eyewear, including contact lenses and eyeglasses (lenses and frames), has no copay, with a combined maximum benefit of $200 every year, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5525-050 (PPO) plan covers dental services, including oral exams with no copay and up to 4 visits per year, and dental x-rays with no copay, with up to 3 x-rays. Restorative services and prosthodontics (removable and fixed) have a 30-40% coinsurance, while other services like fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while the other drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered, requiring prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 5% coinsurance, Prosthetics/Medical Supplies with no copay and 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay and between 10% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5525-050 (PPO) covers diagnostic and radiological services, including all diagnostic services, lab services with no copay, and outpatient X-Ray services with no copay. Diagnostic Procedures/Tests have a copay between $0 and $120, while Diagnostic Radiological Services have a copay up to $325, and Therapeutic Radiological Services have a copay up to $30 with a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-050 (PPO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice H5525-050 (PPO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-050 (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100, and additional days beyond Medicare-covered for SNF, as well as non-Medicare-covered stays for SNF, are not covered.
Other Services See details
The HumanaChoice H5525-050 (PPO) plan covers acupuncture with a $30 copay, and 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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