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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 2025, 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 2025.
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. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $300.00 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 $10500.00 (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 $10500.00 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 has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay a $5 copay for preferred generic drugs at a standard pharmacy, and 45% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-051 (PPO) plan offers a range of benefits, including inpatient and outpatient hospital care, with varying copays depending on the service. This plan also includes coverage for primary care, specialist visits, and mental health services, with copays between $0 and $85. Additional benefits include coverage for ambulance services, emergency services, preventive services, hearing exams and aids, vision services, dental services, and home infusion bundled services. The plan also covers medical equipment, diagnostic and radiological services, home health services, and skilled nursing facility stays, with copays and coinsurance varying by service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $362 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $387 for days 1-5 and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute has no copay for days 91-999. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays are not covered for Inpatient Hospital Psychiatric.
Outpatient Services See details
The HumanaChoice H5525-051 (PPO) plan covers outpatient services including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $360, observation services have a $362 copay, and ASC services and outpatient blood services have no copay. Outpatient substance abuse services for individual sessions have a copay between $35 and $85, and group sessions have a copay between $35 and $85.
Partial Hospitalization See details
Partial Hospitalization is covered by HumanaChoice H5525-051 (PPO) with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The HumanaChoice H5525-051 (PPO) plan covers ambulance services, including ground and air ambulance. Both ground and air ambulance services have a $315 copay, with no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the HumanaChoice H5525-051 (PPO) plan. Emergency Services have a $110 copay and no coinsurance, and Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, each have a $110 copay, with no coinsurance.
Primary Care See details
The HumanaChoice H5525-051 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a copay between $20 and $35. This plan also covers physician specialist services with a $35 copay, mental health specialty services, and psychiatric services with a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a copay between $20 and $35, and additional telehealth benefits range from no copay to a $45 copay.
Preventive Services See details
Preventive services include Medicare-covered preventive services and an annual physical exam with no copay, as well as additional preventive services, kidney disease education services, and other preventive services. The Additional Preventive Services, Kidney Disease Education Services, and Other Preventive Services all have varying copays, with the details for the copays listed in the plan details.
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 have no copay. Prescription hearing aids are partially covered; all types have a copay between $199 and $499 for two hearing aids per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are covered up to $50 every three months.
Vision Services See details
The HumanaChoice H5525-051 (PPO) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5525-051 (PPO) plan covers Medicare Dental Services with a $35 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. 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 are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered with a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment (DME) has a 17% coinsurance with prior authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and medical supplies have a 17% coinsurance, and diabetic supplies have a 10% coinsurance with no copay, while diabetic therapeutic shoes/inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, and Radiological Services. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $105, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $300, and Therapeutic Radiological Services have a maximum copay of $35 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-051 (PPO) plan with no copay and no coinsurance. 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 H5525-051 (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5525-051 (PPO) plan, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100, and additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture with a $35 copay, and an over-the-counter (OTC) items benefit with a maximum coverage amount of $50 every three months. The plan also offers a meal benefit with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and many other services are not covered.
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