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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 features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, you will enjoy no copay for a 1-month or 3-month supply when using a standard pharmacy or preferred mail order. If you utilize standard mail order instead, Tier 1 drugs have a $10 copay for a 1-month supply ($30 for 3-month) and Tier 2 drugs have a $20 copay for a 1-month supply ($60 for 3-month). Tier 3 (Preferred Brand) drugs cost a $30 copay for a 1-month supply at standard pharmacies and preferred mail order, whereas standard mail order costs $47. For Tier 4 (Non-Preferred Drug) prescriptions, you will pay 35% coinsurance across standard pharmacies, preferred mail order, and standard mail order options. Tier 5 (Specialty Tier) medications require a 33% coinsurance for a 1-month supply through standard pharmacies, preferred mail order, or standard mail order.
Additional Benefits
The HumanaChoice Giveback H5525-085 PPO plan offers affordable coverage for core medical needs, with many essential services requiring no copay and no coinsurance. Beneficiaries can access primary care visits, home health services, and annual physical exams at no cost, while specialist visits require a $45 copay. Inpatient hospital stays have no coinsurance but carry a $475 daily copay for the first several days, and emergency room visits feature a $115 copay that is waived if you are admitted. Supplemental benefits under this plan include routine dental cleanings, routine hearing exams, and routine eyewear with no copay or coinsurance. Diagnostic lab work and outpatient X-rays also feature no copay, while durable medical equipment requires no copay and a 16% coinsurance. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days, making this plan a highly practical option for comprehensive care.
Inpatient Hospital See details
HumanaChoice Giveback H5525-085 (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $475 daily copay for days 1 through 5 and no copay for days 6 and beyond, while psychiatric stays require a $475 daily copay for days 1 through 4 and no copay for days 5 through 90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
HumanaChoice Giveback H5525-085 (PPO) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $745, as well as observation services with a $475 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are fully covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and 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 this covered benefit.
Ambulance and Transportation Services See details
HumanaChoice Giveback H5525-085 (PPO) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to 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 are covered with 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. Physical, occupational, speech, and mental health therapies have copays ranging from $20 to $35 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice Giveback H5525-085 (PPO) offers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive services are only partially covered; while a fitness benefit is included with no copay and no coinsurance, services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
HumanaChoice Giveback H5525-085 (PPO) covers hearing services with no deductible and no coinsurance, featuring Medicare-covered exams for a $45 copay and routine exams or fittings for no copay. Prescription hearing aids are partially covered with a copay of $699 to $999 for up to two aids yearly, though over-the-counter options and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by HumanaChoice Giveback H5525-085 (PPO) with no coinsurance, offering a $0 to $45 copay for eye exams and no copay for eyewear, up to annual limits of $75 and $200. This benefit is partially covered, as other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice Giveback H5525-085 (PPO) offers partially covered dental services with a $45 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services like cleanings and exams. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice Giveback H5525-085 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice Giveback H5525-085 (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HumanaChoice Giveback H5525-085 (PPO) covers durable medical equipment with a 16% coinsurance and no copay, and prosthetics and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, whereas diabetic therapeutic shoes and inserts require a $10 copay plus coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice Giveback H5525-085 (PPO) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay and diagnostic services with no coinsurance. Diagnostic procedures and tests have a copay ranging from $0 to $100, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $50 copay.
Home Health Services See details
Home Health Services are covered under the HumanaChoice Giveback H5525-085 (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice Giveback H5525-085 (PPO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, carrying copayments 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 copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not necessary, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
HumanaChoice Giveback H5525-085 (PPO) partially covers other services, offering acupuncture with a $45 copay, no coinsurance, and a limit of 20 treatments per year with prior authorization required. Over-the-counter (OTC) items, meal benefits, and other supplemental services are not covered under this plan.
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