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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 has a $125.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $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) plan has a $300 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $5 copay at preferred mail-order pharmacies and $5 at standard pharmacies. For standard generic drugs, you'll pay a $47 copay. You will pay 45% coinsurance for preferred brand drugs and 29% coinsurance for non-preferred drugs.
Additional Benefits
The HumanaChoice H5525-051 (PPO) plan offers a wide range of benefits with varying cost-sharing. Many services have no copay, including preventive care, routine hearing exams, eyewear, dental exams, and home health services. Other services, such as inpatient hospital stays, outpatient services, emergency services, and primary care, have copays ranging from $15 to $640. This plan also includes coverage for ambulance services with a $315 copay, and offers coinsurance for services like dialysis, medical equipment, and home infusion bundled services. Additionally, there are no copays for several services, including outpatient blood services and lab services.
Inpatient Hospital See details
Inpatient Hospital services are covered by the HumanaChoice H5525-051 (PPO) plan, with a copay of $362 for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute; 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 have no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by the HumanaChoice H5525-051 (PPO) plan. Outpatient Hospital Services have a copay between $0 and $640, Observation Services have a $362 copay, Ambulatory Surgical Center (ASC) Services have no copay, Outpatient Substance Abuse Services have a copay between $40 and $90 for individual and group sessions, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-051 (PPO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
For HumanaChoice H5525-051 (PPO), ambulance services are covered, with a $315 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice H5525-051 (PPO) plan. Emergency Services has a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The HumanaChoice H5525-051 (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a copay between $20 and $35, Physician Specialist Services with a $40 copay, and Mental Health Specialty Services with a $40 copay. The plan does not cover Podiatry Services. Other Health Care Professional services have a copay between $0 and $40, while Psychiatric Services have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a copay between $20 and $35, and Additional Telehealth Benefits have a copay between $0 and $45. Opioid Treatment Program Services have a copay between $40 and $90.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and annual physical exams with no copay. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing services include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $199 and $499, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5525-051 (PPO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Restorative services have a $25 copay, and adjunctive general services have no copay. Fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. There is a $1,000 maximum plan benefit per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HumanaChoice H5525-051 (PPO) plan, 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 under the HumanaChoice H5525-051 (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment and Prosthetics/Medical Supplies, is covered by this plan. Durable Medical Equipment has a 14% coinsurance, and Prosthetic Devices and Medical Supplies have a 14% coinsurance. Diabetic Supplies have a 10% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the HumanaChoice H5525-051 (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $105, and Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $720, while Therapeutic Radiological Services have a maximum copay of $40 and at least 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5525-051 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered under this plan.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Under the "Other Services" benefit, acupuncture has a $40 copay, and the plan covers up to 20 treatments per year. The plan also covers a meal benefit with no copay. However, 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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