A non-government entity
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 2026, 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 2026.
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 $24.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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:
Sign up for HumanaChoice H5525-070 (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 H5525-070 (PPO) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay 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, featuring no copay for a 3-month supply via preferred mail order and a low $5.00 copay for a 1-month supply at standard pharmacies. Tier 3 preferred brand drugs require a $47.00 copay for a 1-month supply across standard pharmacies and mail order options. Higher-tier medications require coinsurance instead of flat copays, with Tier 4 non-preferred drugs carrying a 40% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. This clear pricing structure allows you to accurately anticipate your out-of-pocket prescription costs with this HumanaChoice PPO plan.
Additional Benefits
The HumanaChoice H5525-070 (PPO) plan offers robust coverage for essential medical services, featuring no copays or coinsurance for primary care and specialist doctor visits, home health care, and routine preventive services. For inpatient hospital stays, members pay no coinsurance and a $375 daily copay for the first seven days of acute stays, after which there is no copay. Emergency room visits carry a $115 copay, which is waived if admitted, while urgent care services require a $40 copay. Members also benefit from dental, vision, and hearing coverage, including routine exams with no copay and dental care covered up to a $2,000 annual maximum. Physical, occupational, and speech therapies require a $25 copay, while mental health services have a $35 copay. Durable medical equipment and dialysis services require a 20% coinsurance with no copay, ensuring affordable support for ongoing health needs.
Inpatient Hospital See details
HumanaChoice H5525-070 (PPO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1-7 of acute stays (no copay for days 8 and beyond) and days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5525-070 (PPO) with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
HumanaChoice H5525-070 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice H5525-070 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5525-070 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-070 (PPO) primary care and specialist physician services feature no copay and no coinsurance, while physical, occupational, and speech therapy require a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services carry a $35 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice H5525-070 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, select screenings, and memory fitness. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home/bathroom safety, and counseling are not covered.
Hearing Services See details
HumanaChoice H5525-070 (PPO) hearing services are partially covered, offering Medicare-covered exams, one annual routine exam, and unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered up to two per year with no coinsurance and a copay ranging from $699 to $999, though OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5525-070 (PPO) offers partially covered vision services with no copay, no coinsurance, and no deductible for covered routine exams and select eyewear. While routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered up to specified annual limits, other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-070 (PPO) offers partially covered dental services with no copay and no coinsurance up to a combined in- and out-of-network annual maximum of $2,000. While diagnostic, preventive, and restorative services are covered, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-070 (PPO) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B drugs, such as chemotherapy and insulin, have a coinsurance ranging from no coinsurance to 20%, with insulin requiring a $35 copay and other Part B drugs carrying no copay.
Dialysis Services See details
HumanaChoice H5525-070 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
HumanaChoice H5525-070 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance, with prior authorization required for most items.
Diagnostic and Radiological Services See details
HumanaChoice H5525-070 (PPO) covers diagnostic services with no coinsurance, offering lab services at no copay and diagnostic procedures with a copay ranging from $0 to $120. Covered radiological services require prior authorization and feature no copay for outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a 20% minimum coinsurance with a $0 minimum copay for therapeutic radiology.
Home Health Services See details
HumanaChoice H5525-070 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HumanaChoice H5525-070 (PPO) with no copay and no coinsurance, although prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-070 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H5525-070 (PPO) covers select additional services with no copays and no coinsurance, including chronic illness meal benefits and up to 20 acupuncture treatments per year with prior authorization. Over-the-counter (OTC) items are not covered under this plan.
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