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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 2025, 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 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $4.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $400.00 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 $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 H5525-083 (PPO) plan has a $450 deductible for prescription drugs. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, in the initial coverage phase, you will pay no copay for preferred generic drugs at a standard pharmacy, while you will pay a $20 copay if using standard mail order. For preferred brand drugs, you pay 43% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-083 (PPO) plan offers a range of benefits with varying cost structures. Inpatient hospital stays have a copay, while outpatient services and emergency services have copays ranging from $0 to $450. Preventive services, primary care, vision, and dental services are covered, with some services having no copay. The plan also covers ambulance, hearing, and home health services, as well as dialysis and medical equipment, each with specific copays, coinsurance, or no cost to the member.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $399 copay for days 1-6, and no copay for days 7-90, and for Additional Days, you pay no copay for days 91-999. For Inpatient Hospital Psychiatric, you pay a $399 copay for days 1-5, and no copay for days 6-90. 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 outpatient hospital services with a copay between $0 and $450, observation services with a $399 copay, and ambulatory surgical center services with no copay. Individual and group sessions for outpatient substance abuse have a copay between $45 and $100, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-083 (PPO) plan, with an $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including both ground and air ambulance services, are covered under the HumanaChoice H5525-083 (PPO) plan. Both ground and air ambulance services have a copay of $315.00, and there is 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 by the HumanaChoice H5525-083 (PPO) 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
HumanaChoice H5525-083 (PPO) covers primary care physician services with no copay. Chiropractic services have a $15 copay, while occupational therapy services have a $25 copay. Physician specialist services have a $50 copay, and physical therapy and speech-language pathology services have a $25 copay. Mental health and psychiatric services have a $45 copay for individual and group sessions. Additional telehealth benefits range from no copay to a $50 copay, and opioid treatment program services have a copay between $45 and $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5525-083 (PPO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services, including fitness benefits, glaucoma screening, and diabetes self-management training, are covered with no copay.
Hearing Services See details
The HumanaChoice H5525-083 (PPO) plan covers hearing exams with a $50 copay. Routine hearing exams are covered with no copay, and Fitting/Evaluation for Hearing Aids are covered with no copay. Prescription hearing aids (all types) have a copay between $499 and $799. However, Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$50, routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,250 maximum benefit per year. Medicare Dental Services have a $50 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable & fixed), and Oral and Maxillofacial Surgery have no copay. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5525-083 (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 10% coinsurance and authorization required, Prosthetics/Medical Supplies with coinsurance for Medicare-covered devices and supplies, and Diabetic Equipment with coinsurance and copays for some services. Diabetic Supplies have a coinsurance between 10% and 20%, and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests and lab services. Diagnostic Procedures/Tests have a copay between $0 and $120, while Lab Services have no copay. Radiological Services are covered, with a copay for Medicare-covered diagnostic and therapeutic radiological services, and X-Ray services, and a coinsurance for Medicare-covered X-Ray Services. Diagnostic Radiological Services have a copay of at most $325, Therapeutic Radiological Services have a coinsurance of at least 20% and a copay of at least $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-083 (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 covered by HumanaChoice H5525-083 (PPO), but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-083 (PPO) plan. You will have no 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 for SNF, are not covered.
Other Services See details
The HumanaChoice H5525-083 (PPO) plan covers acupuncture with a $50 copay, and meal benefits with no copay; however, over-the-counter items, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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