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HumanaChoice H5525-051 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-051 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-051 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-051 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Greater Philadelphia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-051 (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 H5525-051 (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 H5525-051 (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.
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 $615.00 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 $10000.00 (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 $10000.00 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 H5525-051 (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies and through preferred mail order, while standard mail order costs up to $30 for a 3-month supply. Tier 2 generic drugs are also highly affordable, with standard pharmacy copays starting at $5 and no copay for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with a slightly discounted $131 copay for a 3-month supply through preferred mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 47% coinsurance, and Tier 5 specialty drugs require 25% coinsurance across all pharmacy and mail order options. This plan offers a clear balance of low-cost generic options alongside cost-sharing for brand-name and specialty medications.
Additional Benefits
The HumanaChoice H5525-051 (PPO) plan offers comprehensive medical coverage with a strong focus on affordable primary and preventive care. Members benefit from no copay and no coinsurance for primary care doctor visits, routine physical exams, and home health services. For hospital care, inpatient acute stays require a $362 daily copay for days one through seven, while outpatient hospital services carry a copay ranging from $0 to $425 with no coinsurance. Supplemental benefits include routine dental, vision, and hearing exams with no copay, alongside a $1,000 annual limit for dental care and up to $350 for eyewear. Emergency services are covered with a $115 copay, which is waived if you are admitted, and urgent care costs a $40 copay. Additionally, durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
HumanaChoice H5525-051 (PPO) partially covers inpatient hospital care with no coinsurance, requiring a $362 daily copay for days 1 to 7 of acute stays and a $416 daily copay for days 1 to 5 of psychiatric stays, followed by no copay for additional covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5525-051 (PPO) outpatient services are covered with no coinsurance, though prior authorization is required for most services. There is no copay for ambulatory surgical center and outpatient blood services, while outpatient substance abuse sessions require a $35 copay, observation services cost a $362 copay per stay, and outpatient hospital services carry a copay ranging from $0 to $425.
Partial Hospitalization See details
HumanaChoice H5525-051 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HumanaChoice H5525-051 (PPO) with a $335 copay and no coinsurance for both ground and air ambulance services, which require prior authorization. While transportation benefits are technically covered, only some services are covered because transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HumanaChoice H5525-051 (PPO) covers emergency services with a $115 copay and no coinsurance, with the copay 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 H5525-051 (PPO) primary care benefits feature no copay and no coinsurance for primary care doctor visits, and a $25 copay with no coinsurance for specialists. Other services like physical therapy, mental health, and telehealth require copays ranging from $0 to $40 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H5525-051 (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, EKGs, and memory fitness. Additional preventive benefits are only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling are not covered.
Hearing Services See details
HumanaChoice H5525-051 (PPO) covers hearing services with no copay or coinsurance for routine exams, fitting evaluations, and over-the-counter hearing aids, while Medicare-covered exams require a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a $99 to $399 copay for up to two aids annually, though inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Vision services under HumanaChoice H5525-051 (PPO) are partially covered with no coinsurance or deductibles, offering routine eye exams and covered eyewear with no copay, while other eye exams carry a copay of up to $25. Annual allowances of $40 for exams and $350 for eyewear are provided, though other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-051 (PPO) partially covers dental services with a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $1,000 yearly maximum. Sub-services that are not covered include fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
HumanaChoice H5525-051 (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5525-051 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5525-051 (PPO) covers durable medical equipment (DME), prosthetics, and medical supplies with a 20% coinsurance and no copay. Covered diabetic supplies feature a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts require a $10 copay and 10% to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5525-051 (PPO) with prior authorization, featuring no copay for lab services and outpatient X-rays. Diagnostic procedures and tests have no coinsurance and copays ranging from $0 to $105, while therapeutic radiological services require a minimum 20% coinsurance and a $35 copay.
Home Health Services See details
HumanaChoice H5525-051 (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5525-051 (PPO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HumanaChoice H5525-051 (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a 3-day prior hospital stay is not needed, additional days beyond the standard 100 days are not covered.
Other Services See details
HumanaChoice H5525-051 (PPO) provides partial coverage for other services, featuring acupuncture for a $25 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while certain other unspecified services under this category are not covered.
Get Personalized Help from a licensed insurance agent
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