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HumanaChoice Giveback H5525-085 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Giveback H5525-085 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Giveback H5525-085 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice Giveback H5525-085 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice Giveback H5525-085 (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 Giveback H5525-085 (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 Giveback H5525-085 (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 $110.00. You must continue to pay paying your reduced 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $12000.00 (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 $12000.00 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 Giveback H5525-085 (PPO) plan offers a $0 drug deductible, allowing your prescription coverage to begin immediately. For Tier 1 preferred generics and Tier 2 generics, there is no copay for a one-month or three-month supply when filled at standard pharmacies or through preferred mail order. If you choose standard mail order, Tier 1 and Tier 2 drugs carry a one-month copay of $10 and $20, respectively. Tier 3 preferred brand drugs have a $30 copay for a one-month supply at standard pharmacies and through preferred mail order, while standard mail order costs $47. Higher-tier medications require coinsurance instead of copays, with Tier 4 non-preferred drugs requiring 35% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance. These coinsurance rates apply across standard pharmacies, preferred mail order, and standard mail order options.
Additional Benefits
The HumanaChoice Giveback H5525-085 (PPO) plan offers robust coverage for essential medical services, featuring no copays or coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits, dental exams, and Medicare-covered dental care, members will pay a predictable $45 copay with no coinsurance. Inpatient hospital stays require a $475 daily copay for the first few days, after which there is no copay for subsequent covered days. Vision care and routine hearing exams are highly accessible with no copays, though prescription hearing aids carry a copay between $699 and $999. Emergency care is available for a $115 copay, while diagnostic lab tests and outpatient X-rays are provided with no copay. Durable medical equipment and dialysis services require no copays but do carry a coinsurance ranging from 17% to 20%.
Inpatient Hospital See details
HumanaChoice Giveback H5525-085 (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $475 daily copay for days 1 through 5 of acute stays and days 1 through 4 of psychiatric stays, with no copay for subsequent covered days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice Giveback H5525-085 (PPO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services carry a copay of $0 to $745 with no coinsurance, observation services require a $475 copay per stay with no coinsurance, and outpatient substance abuse sessions cost a $35 copay with no coinsurance.
Partial Hospitalization See details
HumanaChoice Giveback H5525-085 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5525-085 (PPO) covers Medicare-covered ground and air ambulance services with a $315 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 Giveback H5525-085 (PPO) 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 are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services each require a $115 copay and no coinsurance.
Primary Care See details
HumanaChoice Giveback H5525-085 (PPO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Additional covered benefits like physical, occupational, and speech therapy, mental health sessions, and telehealth have copays ranging from $0 to $45 with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice Giveback H5525-085 (PPO), offering annual physicals, kidney disease education, select screenings, and memory fitness with no copay and no coinsurance. Uncovered supplemental services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by HumanaChoice Giveback H5525-085 (PPO), offering Medicare-covered exams for a $45 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay of $699 to $999 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice Giveback H5525-085 (PPO) offers partially covered vision services with no deductible, no coinsurance, $0 to $45 copays for eye exams, and no copay for contact lenses or eyeglasses. Other eye exams, standalone eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5525-085 (PPO) dental services are partially covered, with Medicare-covered dental requiring a $45 copay and no coinsurance, and preventive services like cleanings and exams available with no copay and no coinsurance. While many restorative and surgical benefits are covered, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice Giveback H5525-085 (PPO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, insulin, and other drugs carry a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice Giveback H5525-085 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is covered by HumanaChoice Giveback H5525-085 (PPO), featuring a 17% coinsurance and no copay for durable medical equipment (DME), and a 20% coinsurance with no copay for prosthetics and medical supplies. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay, with coverage subject to manufacturer limitations and prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice Giveback H5525-085 (PPO), though prior authorization is required. Diagnostic lab services and outpatient X-rays have no copay, diagnostic procedures and tests feature a copay ranging from $0 to $100 with no coinsurance, and therapeutic radiological services require a minimum $50 copay and 20% coinsurance.
Home Health Services See details
HumanaChoice Giveback H5525-085 (PPO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice Giveback H5525-085 (PPO) with no coinsurance and prior authorization, although only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, featuring copays ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
HumanaChoice Giveback H5525-085 (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no prior three-day hospital stay but requiring prior authorization. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services for HumanaChoice Giveback H5525-085 (PPO) are partially covered, featuring acupuncture treatments with a $45.00 copay, no coinsurance, and a limit of 20 visits per year with prior authorization. Supplemental benefits such as over-the-counter (OTC) items and meal benefits are not covered.
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