A non-government entity
HumanaChoice H5525-086 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-086 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-086 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-086 (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 H5525-086 (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 H5525-086 (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 H5525-086 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. 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 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 $5800.00 (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 $5800.00 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:
Sign up for HumanaChoice H5525-086 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice H5525-086 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also budget-friendly, requiring a $5 copay for a 1-month supply at standard pharmacies and no copay for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs generally carry a $47 copay for a 1-month supply, though a 3-month supply through preferred mail order is slightly lower at $131. For higher-tier medications, the plan charges coinsurance instead of copays, requiring a 47% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The HumanaChoice H5525-086 (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive care, and home health services. Specialist doctor visits require a low $15 copay, while inpatient hospital stays carry a $325 copay per stay with no coinsurance. Emergency care is covered with a $130 copay, which is waived upon hospital admission, and urgent care visits require a $50 copay. For additional health needs, the plan provides a $2,000 annual limit on dental services with no copay for preventive care, plus vision and hearing benefits that include routine exams with no copay. Diagnostic lab work and outpatient X-rays are also available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Members also benefit from up to 24 free one-way transportation trips per year and acupuncture coverage for a $15 copay.
Inpatient Hospital See details
HumanaChoice H5525-086 (PPO) covers inpatient acute and psychiatric hospital stays with a $325 copayment per stay and no coinsurance, requiring prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5525-086 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $400 copay for outpatient hospital services, a $325 copay per stay for observation services, and a $30 to $35 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HumanaChoice H5525-086 (PPO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
HumanaChoice H5525-086 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance per trip. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
HumanaChoice H5525-086 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-086 (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, and mental health therapies require copays between $20 and $30 with no coinsurance, while podiatry is not covered, and chiropractic care covers some services but routine and other chiropractic services are not covered.
Preventive Services See details
HumanaChoice H5525-086 (PPO) preventive services are partially covered with no copay and no coinsurance for annual exams, kidney disease education, select screenings, and a memory fitness benefit. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, and re-admission prevention. Other non-covered services include wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Hearing services under HumanaChoice H5525-086 (PPO) are covered with no deductible and no coinsurance, requiring a $15 copay for Medicare-covered exams but no copay for annual routine exams, fitting evaluations, or OTC hearing aids. Prescription hearing aids are partially covered with a copay between $699 and $999 for up to two devices annually, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5525-086 (PPO) with no coinsurance, featuring a $0 to $15 copay for eye exams (up to $75 yearly) and no copay for select eyewear (up to $250 yearly). Other eye exam services, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-086 (PPO) partially covers dental services up to a $2,000 annual limit, featuring no copay and no coinsurance for preventive care, endodontics, periodontics, and oral surgery, while restorative and fixed prosthodontics require a 30% to 40% coinsurance and no copay. Medicare-covered dental services have a $15 copay and no coinsurance, but fluoride, implants, removable prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-086 (PPO) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may be required. Related Medicare Part B chemotherapy, radiation, and other Part B drugs carry no copay and 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-086 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice H5525-086 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies from specified manufacturers feature a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5525-086 (PPO) covers diagnostic and radiological services with no coinsurance for diagnostic services, no copay for lab services and outpatient X-rays, and a copay of $0 to $105 for diagnostic procedures. Therapeutic radiological services require a minimum $30 copay and a minimum 20% coinsurance, with prior authorization required.
Home Health Services See details
Home Health Services are covered under the HumanaChoice H5525-086 (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the HumanaChoice H5525-086 (PPO) plan with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered in practice and carry copayments between $10 and $15.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-086 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, though a prior three-day inpatient hospital stay is not, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services covered by HumanaChoice H5525-086 (PPO) include acupuncture for a $15.00 copay and no coinsurance for up to 20 treatments per year, alongside chronic illness meal benefits with no copay and no coinsurance. Over-the-counter items are also covered with no copay and no coinsurance via reimbursement, though some CMS OTC list drugs are excluded.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved