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HumanaChoice Giveback H5525-058 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5525-058 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5525-058 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Giveback H5525-058 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice Giveback H5525-058 (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 Giveback H5525-058 (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 Giveback H5525-058 (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 $75.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $300.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $225.00 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 $12000.00 (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 $12000.00 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 Giveback H5525-058 (PPO) plan has a $225 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For generic drugs, the copay ranges from $5 to $47. For preferred brand drugs, you will pay 40% coinsurance at a preferred pharmacy and 42% at a standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The HumanaChoice Giveback H5525-058 (PPO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and home health services may have copays, depending on the service. Many preventive services, hearing exams, vision exams, and dental services are covered with no copay. The plan also covers ambulance services, emergency services, and various therapies with copays. Diagnostic and radiological services, medical equipment, and dialysis services are covered with copays or coinsurance. The plan also includes coverage for acupuncture, over-the-counter items, and cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a $475 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute have no copay for days 91-999. 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 include coverage for outpatient hospital services with a copay between $0 and $745, observation services with a $475 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $40 and $100 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice Giveback H5525-058 (PPO) plan, but requires prior authorization. You will pay a $60 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation 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 under the HumanaChoice Giveback H5525-058 (PPO) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, and no coinsurance.
Primary Care See details
The HumanaChoice Giveback H5525-058 (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $20-$35 copay, and Physician Specialist Services with a $50 copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $40 minimum and maximum copay. Physical Therapy and Speech-Language Pathology Services have a $20-$35 copay, and Additional Telehealth Benefits have a $0-$50 copay. Podiatry Services are not covered.
Preventive Services See details
The HumanaChoice Giveback H5525-058 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including fitness benefits, kidney disease education services, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with no copay. However, health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $50 copay, routine hearing exams (1 per year) with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $699 and $999 for 2 visits per year, while OTC hearing aids are covered up to $15 every three months. Prescription hearing aids for inner ear, outer ear, and over the ear are not covered.
Vision Services See details
For the HumanaChoice Giveback H5525-058 (PPO) plan, vision services include eye exams with a copay between $0 and $50, and eyewear with no copay. Routine eye exams, 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
Dental Services include coverage for Medicare Dental Services with a $50 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. However, 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 and require prior authorization. The plan covers Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice Giveback H5525-058 (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical equipment is covered, including Durable Medical Equipment (DME) with no copay and no coinsurance. Prosthetic Devices and Medical Supplies are covered, with 3% coinsurance for both. Diabetic Equipment is covered, including Diabetic Supplies with 4-10% coinsurance and Diabetic Therapeutic Shoes/Inserts with a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have a copay up to $50 and 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 Giveback H5525-058 (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 covered, but no specific services are covered under this plan. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice Giveback H5525-058 (PPO) with prior authorization required. There is no copay for days 1-20, and a $214 copay per day for days 21-100; additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HumanaChoice Giveback H5525-058 (PPO) plan covers acupuncture with a $50 copay per visit for up to 20 treatments per year, and also covers over-the-counter items with a maximum benefit of $15 every three months. However, meal benefits, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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