A non-government entity
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 2025, 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, OR, WY. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $78.00. 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 $700.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $350.00 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 $12450.00 (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 $12450.00 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:
Sign up for HumanaChoice H5525-054 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice H5525-054 (PPO) plan has a $350 deductible for prescription drugs. Once you meet the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, in the initial coverage phase, you will pay $15 for preferred generic drugs at a standard or preferred mail pharmacy. For preferred brand drugs, you will pay 44% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The HumanaChoice H5525-054 (PPO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay, while outpatient services include copays and coinsurance depending on the service. This plan includes coverage for primary care, specialist visits, mental health, and physical therapy, with copays ranging from $10-$55. Preventive services, such as an annual physical exam, have no copay, and the plan also covers hearing, vision, and dental services with various copays, coinsurance, and annual maximums.
Inpatient Hospital See details
Inpatient Hospital services are covered, including acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $478 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric costs $407 for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a 20% coinsurance and a copay between $0 and $400, observation services with a $478 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a minimum of 20% and maximum 20% coinsurance and a $55 copay, and outpatient blood services with no copay. Individual and group sessions for outpatient substance abuse have a minimum of 20% and maximum 20% coinsurance and a $55 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-054 (PPO) plan, but requires prior authorization. There is an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5525-054 (PPO) plan. Ground ambulance services have a $315 copay, and air ambulance services have a $1250 copay, but there is no coinsurance for either. 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. For Emergency Services, the copay is $110, with no coinsurance. For Urgently Needed Services, the copay is $45, with no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a copay of $110, with no coinsurance.
Primary Care See details
The HumanaChoice H5525-054 (PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, and occupational therapy services with a $35 copay, but routine chiropractic care is not covered. This plan also covers specialist visits with a $55 copay, mental health services with no copay for individual or group sessions, and physical therapy or speech-language pathology services with a $35 copay. Additionally, additional telehealth benefits are covered with a copay ranging from $0 to $55, and opioid treatment program services with a 20% coinsurance and a $55 copay.
Preventive Services See details
The HumanaChoice H5525-054 (PPO) plan covers preventive services, including an annual physical exam with no copay, and kidney disease education services, with a minimum and maximum copay of $0. Other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit have no copay. However, health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
The HumanaChoice H5525-054 (PPO) plan covers hearing exams with a $55 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered with no copay, and prescription hearing aids are covered with a copay between $699 and $999 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The HumanaChoice H5525-054 (PPO) plan covers vision services including eye exams with a copay of $0-$55, 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 H5525-054 (PPO) plan covers Medicare Dental Services with a $55 copay, oral exams with no copay, and dental x-rays with no copay. Other covered dental services include Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services with no copay and 30-40% coinsurance, Adjunctive General Services, Endodontics, Periodontics, Oral and Maxillofacial Surgery, and Prosthodontics, fixed with no copay and 30-40% coinsurance; however, Fluoride Treatment, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a $1,000 annual maximum for all dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-054 (PPO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetics/Medical Supplies have a 20% coinsurance for Medicare-covered devices and supplies; Diabetic Supplies have a 10-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered with a copay of up to $55 for diagnostic procedures/tests and no copay for lab services. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-054 (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
HumanaChoice H5525-054 (PPO) covers Cardiac Rehabilitation Services, but does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-054 (PPO) plan. There is no copay for days 1-20 and days 81-100, but there is a $214 copay for days 21-80.
Other Services See details
The HumanaChoice H5525-054 (PPO) plan covers acupuncture with a $55 copay, and a meal benefit with no copay. Other services like over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved