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HumanaChoice H5525-070 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-070 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-070 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-070 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in North Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-070 (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 H5525-070 (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 H5525-070 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.20. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $590.00 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 $14000.00 (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 $14000.00 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 H5525-070 (PPO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for a standard generic drug, you will pay a $47.00 copay. After your total drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-070 (PPO) plan offers a variety of benefits, including inpatient hospital stays with a $399 copay for the first few days, outpatient services with copays ranging from $0 to $450, and emergency services with a $110 copay. Primary care and preventive services are covered with no copay. Additional benefits include coverage for hearing and vision services, with no copay for eye exams and hearing exams, and a combined maximum benefit of $300 per year for eyewear. Dental services are covered with no copay for many services, and a $1,500 annual maximum. The plan also covers home health services and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, both requiring prior authorization. For acute care, you'll pay a $399 copay for days 1-6, and no copay for days 7-90, with no coinsurance; additional days have no copay. Psychiatric care has a $399 copay for days 1-5, and no copay for days 6-90, with no coinsurance; additional days are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $450, Observation Services with a $399 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $45 and $100 for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-070 (PPO) plan, requiring prior authorization and a copay of $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5525-070 (PPO) plan. Both ground and air ambulance services have a $315 copay, while 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 H5525-070 (PPO) plan. Emergency Services has a $110 copay with no coinsurance, Urgently Needed Services has a $45 copay with no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay with no coinsurance.
Primary Care See details
The HumanaChoice H5525-070 (PPO) plan covers primary care physician services and specialist services with no copay. Chiropractic services have a $15 copay. Occupational therapy services have a $25 copay. Physical therapy and speech-language pathology services have a $25 copay. Individual and group sessions for both mental health and psychiatric services have a $45 copay. Additional telehealth benefits have a copay between $0 and $45. Opioid treatment program services have a copay between $45 and $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for Medicare-covered services, annual physical exams, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following the Welcome Visit. Some additional preventive services are covered, but health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have no copay, and routine hearing exams and fitting/evaluation for hearing aids also have no copay. Prescription hearing aids have a copay between $699 and $999, while prescription hearing aids - inner ear, outer ear, and over the ear, along with OTC hearing aids, are not covered.
Vision Services See details
The HumanaChoice H5525-070 (PPO) plan offers vision services including eye exams and eyewear. Eye exams have no copay, and eyewear has a combined maximum benefit of $300 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Under the HumanaChoice H5525-070 (PPO) plan, dental services are covered, with a $1,500 annual maximum. Oral exams, dental x-rays, other diagnostic and preventive dental services, and prophylaxis (cleaning) have no copay, while fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-070 (PPO) plan, with prior authorization required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have a coinsurance between 10% and 20% with no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay that may range from $0 to $120, and lab services with no copay. Outpatient X-Ray services have no copay, while Diagnostic Radiological Services may have a copay of up to $325, and Therapeutic Radiological Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5525-070 (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 not covered by the HumanaChoice H5525-070 (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-070 (PPO) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture and a meal benefit. Acupuncture has no copay, and the plan covers up to 20 treatments per year. The meal benefit has no copay. Other services such as over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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