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Humana Dual Select H5525-072 (PPO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select H5525-072 (PPO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Dual Select H5525-072 (PPO D-SNP) in 2025, please refer to our full plan details page.
Humana Dual Select H5525-072 (PPO D-SNP) is a PPO D-SNP 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 Humana Dual Select H5525-072 (PPO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Dual Select H5525-072 (PPO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Dual Select H5525-072 (PPO D-SNP).
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 Humana Dual Select H5525-072 (PPO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.60. 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 $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 $9350.00 (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 $9350.00 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 Humana Dual Select H5525-072 (PPO D-SNP) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs based on the tier, pharmacy, and day supply, until your total drug costs reach $2000. Once your yearly out-of-pocket drug costs reach $2000.00, you will enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, and the monthly premium is $45.60.
Additional Benefits
The Humana Dual Select H5525-072 (PPO D-SNP) plan offers comprehensive coverage, including inpatient and outpatient services, with varying copays depending on the service. The plan has no copays for primary care visits, many preventive services, and dental services, but other services like specialist visits, and hearing exams do have copays. This plan also includes benefits like ambulance services, home health, and medical equipment, with copays or coinsurance applying to some services. Additionally, the plan offers coverage for hearing and vision, with copays for exams, and no copays for eyewear and hearing aid fittings.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $399 copay for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute have no copay, and Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $0-$450, observation services with a $399 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay of $45-$100 for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Dual Select H5525-072 (PPO D-SNP) plan, but requires prior authorization. You will pay a copay of $80 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 Humana Dual Select H5525-072 (PPO D-SNP) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay.
Primary Care See details
The Humana Dual Select H5525-072 (PPO D-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, and mental health specialty services with a $45 copay for individual and group sessions. The plan also covers other health care professional services with a copay between $0 and $25, psychiatric services with a $45 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $45, and opioid treatment program services with a copay between $45 and $100. Routine Chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Dual Select H5525-072 (PPO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Humana Dual Select H5525-072 (PPO D-SNP) covers hearing exams with a $25 copay, routine hearing exams with no copay for one exam every year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered; prescription hearing aids (all types) have no copay for 2 visits every three years, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Dual Select H5525-072 (PPO D-SNP) plan covers vision services, including eye exams with a copay between $0 and $25, and eyewear with no copay. 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
The Humana Dual Select H5525-072 (PPO D-SNP) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery, all with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered, while there is a $1500 annual maximum for Other Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while other drugs have a coinsurance between 0% and 20% with no copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Dual Select H5525-072 (PPO D-SNP) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, and Diabetic Equipment with 20% coinsurance and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are covered. Diagnostic procedures and tests have a maximum copay of $120 and a minimum coinsurance of 20%, while lab services have no copay. Diagnostic radiological services have a maximum copay of $325, and therapeutic radiological services have a maximum copay of $25 and a minimum coinsurance of 20%. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered 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 by Humana Dual Select H5525-072 (PPO D-SNP), but the plan does not cover the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit, and there is a copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Dual Select H5525-072 (PPO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional and non-Medicare covered SNF days are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter items, and meal benefits. Acupuncture has a $25 copay, and is limited to 20 treatments per year. Over-the-counter items are covered with a maximum of $1200 per year, and meal benefits are covered with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management are not covered.
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