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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 2026, 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 2026.
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 $33.50. 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:
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Drug Coverage
The Humana Dual Select H5525-072 (PPO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay for one-month and three-month supplies at standard pharmacies or through preferred mail order. If you use standard mail order, Tier 1 drugs carry a $10 to $30 copay, while Tier 2 drugs require a $20 to $60 copay. For Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs, you will pay a 25% coinsurance. This 25% coinsurance rate applies to standard pharmacies, preferred mail order, and standard mail order options. Specialty medications under Tier 5 are limited to a one-month supply at this same coinsurance rate.
Additional Benefits
The Humana Dual Select H5525-072 (PPO D-SNP) plan offers comprehensive coverage designed to keep your out-of-pocket costs low, featuring no copays and no coinsurance for primary care visits, preventive services, home health care, and routine dental, vision, and hearing exams. For specialized care, members pay a low $25 copay with no coinsurance for specialist visits, physical therapy, and acupuncture. Routine dental care is covered up to a $1,500 annual limit, and the plan provides up to a $400 annual allowance for eyewear. For more intensive medical needs, inpatient hospital stays require a $399 daily copay for the first several days before transitioning to no copay, while emergency room visits carry a $115 copay that is waived if you are admitted. Durable medical equipment, dialysis, and some diagnostic services require a 20% coinsurance with no copay. Additionally, skilled nursing facility stays are highly affordable, requiring no copay for the first 20 days of care.
Inpatient Hospital See details
Humana Dual Select H5525-072 (PPO D-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $399 copay per day for days 1 to 6 and no copay for days 7 and beyond, whereas psychiatric stays require a $399 copay per day for days 1 to 5 and no copay for days 6 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Dual Select H5525-072 (PPO D-SNP) with no coinsurance across all benefits. This plan features no copays for ambulatory surgical center and blood services, a $35 copay for outpatient substance abuse sessions, a $399 copay per stay for observation services, and a copay ranging from $0 to $450 for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Dual Select H5525-072 (PPO D-SNP) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Dual Select H5525-072 (PPO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Humana Dual Select H5525-072 (PPO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Dual Select H5525-072 (PPO D-SNP) covers primary care provider visits with no copay and no coinsurance, while specialist visits and physical, occupational, or speech therapy require a $25 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $35 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Dual Select H5525-072 (PPO D-SNP) covers preventive services, such as annual physical exams, kidney education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive services are partially covered, providing a memory fitness benefit with no copay and no coinsurance, but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, and re-admission prevention. Other excluded sub-services include wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Dual Select H5525-072 (PPO D-SNP) covers hearing services, featuring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with no copay or coinsurance for up to two aids every three years, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Dual Select H5525-072 (PPO D-SNP) partially covers vision services with no coinsurance and no copays for covered services, though prior authorization is required. The plan covers one routine eye exam per year (up to $40) and one pair of contact lenses or eyeglasses per year (up to a combined $400 limit), while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Dual Select H5525-072 (PPO D-SNP), featuring a $1,500 annual limit with no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental services require a $25 copay and no coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Dual Select H5525-072 (PPO D-SNP) covers home infusion bundled services, which require prior authorization and step therapy. Covered Part B insulin drugs have a $35 copay and 0% to 20% coinsurance, other Part B drugs feature no copay and 0% to 20% coinsurance, and chemotherapy drugs carry a 0% to 20% coinsurance with applicable copayments.
Dialysis Services See details
Humana Dual Select H5525-072 (PPO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by Humana Dual Select H5525-072 (PPO D-SNP) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic services. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Dual Select H5525-072 (PPO D-SNP) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic procedures and tests have a copay ranging from $0 to $120 and a minimum 20% coinsurance, while lab services and outpatient X-rays feature no copay but carry coinsurance. Therapeutic radiological services require a minimum $25 copay and 20% coinsurance, while diagnostic radiological services feature no copay.
Home Health Services See details
Home health services are covered by Humana Dual Select H5525-072 (PPO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Dual Select H5525-072 (PPO D-SNP) does not cover cardiac rehabilitation services, meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation.
Skilled Nursing Facility (SNF) See details
Humana Dual Select H5525-072 (PPO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Dual Select H5525-072 (PPO D-SNP) covers acupuncture with a $25 copay and no coinsurance for up to 20 treatments per year, as well as meal benefits with no copay or coinsurance. Over-the-counter (OTC) items are also covered with no copay or coinsurance, although this benefit is partially covered since it excludes some drugs on the CMS OTC list.
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