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HumanaChoice H5525-083 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-083 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-083 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-083 (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 H5525-083 (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 H5525-083 (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 H5525-083 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $450.00 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 HumanaChoice H5525-083 (PPO) Medicare plan features an annual drug deductible of $450. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs when using a standard pharmacy or preferred mail order. If you choose standard mail order, a 1-month supply costs a $10 copay for Tier 1 and a $20 copay for Tier 2 drugs. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, while a 3-month supply costs $141, or $131 if ordered through preferred mail. Tier 4 non-preferred drugs require a 47% coinsurance for both 1-month and 3-month supplies. Finally, Tier 5 specialty tier drugs carry a 27% coinsurance for a 1-month supply.
Additional Benefits
The HumanaChoice H5525-083 (PPO) plan offers robust coverage with no copay for primary care visits, routine preventive services, and home health care. Specialist visits, mental health services, and physical therapy require predictable copays ranging from $25 to $35, while inpatient hospital stays have a $375 daily copay for the first several days and no copay thereafter. Emergency care is available for a $115 copay, which is waived if you are admitted, and urgent care carries a $40 copay. For auxiliary care, the plan features a generous $1,750 dental benefit and a $150 annual vision allowance for glasses or contacts with no copays. Routine hearing exams and fittings also require no copay, though prescription hearing aids have copays ranging from $99 to $699. Specialized needs like durable medical equipment and dialysis require coinsurance payments ranging from 10% to 20% with no copay.
Inpatient Hospital See details
HumanaChoice H5525-083 (PPO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 through 7 for acute stays and days 1 through 5 for psychiatric stays, with no copay for subsequent days. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5525-083 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay, and outpatient substance abuse sessions for a $35 copay. Outpatient hospital services have a copay ranging from $0 to $450, while observation services require a $375 copay per stay, with prior authorization required for most of these services.
Partial Hospitalization See details
HumanaChoice H5525-083 (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 H5525-083 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay per trip and no coinsurance, subject to prior authorization requirements. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5525-083 (PPO) covers emergency services with a $115 copay and no coinsurance, and this copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services are available with 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 H5525-083 (PPO) covers primary care physician visits with no copay and no coinsurance, while specialist, psychiatric, mental health, and opioid treatment services require a $35 copay and no coinsurance. Physical, occupational, and speech therapies have a $25 copay and no coinsurance, but podiatry is not covered and chiropractic services only cover some services, with routine and other chiropractic care excluded.
Preventive Services See details
HumanaChoice H5525-083 (PPO) covers preventive services—including annual physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs—with no copay and no coinsurance. However, additional preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, bathroom safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5525-083 (PPO) hearing services cover Medicare-covered exams for a $35 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $99 to $699, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H5525-083 (PPO) provides partially covered vision services with no deductibles, no coinsurance, and prior authorization requirements. Routine eye exams have no copay (limited to one per year with a $75 maximum), while covered contact lenses and eyeglasses have no copay up to a $150 annual combined limit. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by HumanaChoice H5525-083 (PPO), offering up to a $1,750 annual maximum benefit for combined in-network and out-of-network care. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance, though fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-083 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and other drugs, require a coinsurance ranging from no coinsurance up to 20%, while covered Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered by HumanaChoice H5525-083 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
HumanaChoice H5525-083 (PPO) covers durable medical equipment (DME) with a 19% coinsurance and no copay, and prosthetic devices or 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.
Diagnostic and Radiological Services See details
HumanaChoice H5525-083 (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for lab services, and a $0 to $120 copay for procedures. Radiological services feature no copay for outpatient X-rays, diagnostic radiology starting at no copay, and therapeutic radiology requiring a minimum 20% coinsurance and a minimum $35 copay.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5525-083 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H5525-083 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5525-083 (PPO) with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the standard Medicare-covered limit.
Other Services See details
HumanaChoice H5525-083 (PPO) covers acupuncture with a $35 copay, no coinsurance, and a limit of 20 treatments per year, as well as chronic illness meal benefits with no copay and no coinsurance. Both of these services require prior authorization, while over-the-counter (OTC) items are not covered.
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