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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 $11000.00 (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 $11000.00 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) Medicare plan features an annual drug deductible of $615. Under the initial coverage phase, Tier 1 preferred generic drugs have no copay when filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, starting with a $5 copay for a one-month supply at standard pharmacies and no copay for a three-month supply via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a one-month supply across standard pharmacies and mail-order options. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 47% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The HumanaChoice H5525-051 (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits, routine preventive services, and home health services. Specialist visits, urgent care, and emergency services are covered with flat copayments and no coinsurance. For inpatient hospital stays, members pay daily copays for the first few days of their stay, after which there is no copay or coinsurance. This Medicare PPO plan also includes dental, vision, and hearing benefits, featuring no copay and no coinsurance for routine dental cleanings and routine annual eye exams, alongside a $400 limit for covered eyewear with no copay. Routine hearing exams have no copay, while prescription hearing aids require copayments ranging from $199 to $499 with no coinsurance. Additionally, diagnostic lab services are covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care under HumanaChoice H5525-051 (PPO) is covered with no coinsurance, requiring prior authorization and a daily copay of $362 for days 1-7 of acute stays and $387 for days 1-5 of psychiatric stays, after which there is no copay. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
HumanaChoice H5525-051 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $640, while observation services cost $362 per stay and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by HumanaChoice H5525-051 (PPO) with a $35.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
HumanaChoice H5525-051 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Although some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
HumanaChoice H5525-051 (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 require a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-051 (PPO) features primary care physician visits with no copay and no coinsurance, alongside specialist visits for a $40 copay and no coinsurance. Therapy, mental health, and telehealth services have copays ranging from $0 to $40 with no coinsurance, though podiatry is not covered and only some chiropractic services are covered, with routine and other chiropractic care excluded.
Preventive Services See details
HumanaChoice H5525-051 (PPO) preventive services are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, glaucoma screenings, and a memory fitness benefit. Supplemental services such as health education, in-home safety assessments, personal emergency response systems, and nutritional therapy are not covered.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5525-051 (PPO), which features a $40 copay and no coinsurance for Medicare-covered exams, and no copay for routine exams and fitting evaluations. Prescription hearing aids are covered with a copay of $199 to $499 and no coinsurance, while OTC hearing aids and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5525-051 (PPO) with no deductibles, no coinsurance, and a $0 to $40 copay for eye exams, including one routine annual exam with no copay. Covered eyewear, including one yearly pair of contact lenses or eyeglasses (lenses and frames), has no copay up to a $400 limit, while other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services under HumanaChoice H5525-051 (PPO) are partially covered up to a $1,000 annual maximum, featuring no copay and no coinsurance for preventive care like cleanings and exams, a $25 copay and no coinsurance for restorative services, and a $40 copay and no coinsurance for Medicare-covered dental. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-051 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a 0% to 20% coinsurance, while covered Part B insulin requires a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5525-051 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
HumanaChoice H5525-051 (PPO) covers medical equipment, including durable medical equipment (DME), medical supplies, and prosthetics, with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5525-051 (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $105 copay for diagnostic procedures, while radiological services range from no copay for X-rays and diagnostic radiology to a minimum $40 copay and 20% minimum coinsurance for therapeutic services.
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
Cardiac Rehabilitation Services are covered by HumanaChoice H5525-051 (PPO) with no coinsurance, although prior authorization is required. While some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered in practice and require copayments ranging from $10 to $30.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-051 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100; additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HumanaChoice H5525-051 (PPO), including acupuncture for a $40 copay and no coinsurance up to 20 treatments per year, and chronic illness meal benefits with no copay or coinsurance. Prior authorization is required for these covered services, while over-the-counter (OTC) items are not covered.
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