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HumanaChoice H5525-054 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-054 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-054 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-054 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in ID, MT, OR, WY. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-054 (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 H5525-054 (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 H5525-054 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $64.00. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $13900.00 (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 $13900.00 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 H5525-054 (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, with standard pharmacy copays starting at $5 for a 1-month supply and no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order options. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 46% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance. These structured cost-sharing tiers help you easily estimate your out-of-pocket prescription costs under this Humana Medicare PPO plan.
Additional Benefits
The HumanaChoice H5525-054 (PPO) plan offers comprehensive medical coverage, featuring no copay for primary care visits and a $45 copay for specialist care. Inpatient hospital stays require a $478 copay for days 1 through 5, while outpatient services range from no copay up to a $400 copay with no coinsurance. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within 24 hours. For extra wellness benefits, the plan provides routine vision and hearing exams with no copay, alongside dental coverage up to a $1,000 annual limit. Preventive dental care requires no copay, while comprehensive restorative services require 30% to 40% coinsurance. Additionally, diagnostic lab work and home health services are covered with no copay, helping to keep your out-of-pocket costs predictable.
Inpatient Hospital See details
HumanaChoice H5525-054 (PPO) covers inpatient acute hospital stays with no coinsurance and a $478 copay for days 1 to 5, and psychiatric stays with a $407 copay for days 1 to 5, with no copay for subsequent days. Room upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5525-054 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $400, observation services require a $478 copay per stay, and outpatient substance abuse sessions have a copay ranging from $0 to $35.
Partial Hospitalization See details
HumanaChoice H5525-054 (PPO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to access these covered benefits.
Ambulance and Transportation Services See details
HumanaChoice H5525-054 (PPO) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, both with no coinsurance and requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5525-054 (PPO) covers emergency services with a $115 copay, which is waived if admitted to the hospital within 24 hours, and no coinsurance. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-054 (PPO) features primary care, mental health, and psychiatric services with no copay and no coinsurance. Specialist visits require a $45 copay and no coinsurance, therapy services carry a $35 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice H5525-054 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and diabetes self-management training. Although some services are covered, additional benefits such as fitness programs, health education, weight management, and personal emergency response systems are not covered.
Hearing Services See details
HumanaChoice H5525-054 (PPO) provides partially covered hearing services, featuring no copay or coinsurance for one annual routine exam and unlimited fitting evaluations, while Medicare-covered exams require a $45 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay ranging from $699 to $999 and no coinsurance, though OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5525-054 (PPO) with no deductibles and no coinsurance, featuring a $0 to $45 copay for eye exams (no copay for routine exams) and no copay for covered eyewear. While routine exams, contact lenses, and eyeglasses (lenses and frames) are covered up to yearly limits, other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-054 (PPO) offers partially covered dental services with a $1,000 annual limit, featuring a $45 copay and no coinsurance for Medicare-covered dental. Preventive and most comprehensive services require no copay and no coinsurance, though restorative and fixed prosthodontics require 30% to 40% coinsurance with no copay, and fluoride, implants, orthodontics, maxillofacial prosthetics, and removable prosthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-054 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance up to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance up to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5525-054 (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice H5525-054 (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with 20% coinsurance and no copay. Diabetic supplies are covered with 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5525-054 (PPO) covers diagnostic services with no coinsurance, offering lab services at no copay and diagnostic procedures with a copay ranging from $0 to $55. Covered radiological services feature outpatient X-rays with no copay, diagnostic radiological services starting at no copay, and therapeutic radiological services requiring a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5525-054 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5525-054 (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-054 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 86 to 100, a $218 daily copay for days 21 to 85, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5525-054 (PPO) covers acupuncture with a $45 copay, no coinsurance, and a limit of 20 treatments per year, alongside a chronic illness meal benefit with no copay and no coinsurance. Both of these covered services require prior authorization, while over-the-counter (OTC) items are not covered.
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