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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 $29.00. 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 $6050.00 (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 $6050.00 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 H5525-086 (PPO) plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay when filled at standard pharmacies or through preferred mail order. Tier 2 generic medications cost a $5 copay for a 1-month supply at standard pharmacies, and you can get a 3-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and mail-order options. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 47% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply. This plan offers various savings opportunities, particularly when utilizing preferred mail-order services for generic prescriptions.
Additional Benefits
The HumanaChoice H5525-086 (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a low $15 copay, while inpatient hospital stays incur a $325 copay per stay with no coinsurance. Emergency care is available with a $130 copay, and urgent care visits cost $50, helping you manage unexpected healthcare expenses. For supplemental care, this plan provides routine dental, vision, and hearing exams with no copay and no coinsurance, though certain services like restorative dental work and medical equipment require coinsurance up to 40% and 20% respectively. Additionally, members benefit from no copay on up to 24 one-way transportation trips to plan-approved locations and select over-the-counter items. Skilled nursing facility care is also covered with daily copays starting at $10 for the first 20 days.
Inpatient Hospital See details
HumanaChoice H5525-086 (PPO) covers inpatient acute and psychiatric hospital stays with a $325 copayment per stay, no coinsurance, and prior authorization required. The benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services for HumanaChoice H5525-086 (PPO) are covered with no coinsurance, featuring a $0 to $400 copay for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions have a $30 to $35 copay.
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
Ambulance and transportation services are covered by HumanaChoice H5525-086 (PPO), featuring a $335 copay and no coinsurance for ground and air ambulance services. Transportation is partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
HumanaChoice H5525-086 (PPO) covers emergency services with a $130 copay, which is waived if you are admitted to the hospital within 24 hours, and no coinsurance. Urgently needed care is covered with 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) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Additional benefits like mental health, physical therapy, and telehealth require copays ranging from $0 to $50 with no coinsurance, while podiatry is not covered, and for chiropractic care, some services are covered 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 physical exams, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs. However, several additional preventive benefits are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5525-086 (PPO) covers hearing services with a $15 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with a copay of $699 to $999 and no coinsurance for up to two devices per year (excluding inner, outer, and over-the-ear types), while over-the-counter (OTC) hearing aids are covered with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by HumanaChoice H5525-086 (PPO) with no copays, no coinsurance, and no deductibles for routine eye exams and eyewear, though prior authorization is required. Covered benefits include one routine eye exam per year (up to $40) and contact lenses or eyeglasses up to a $300 annual limit, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-086 (PPO) dental services are partially covered up to a $2,000 annual limit, featuring no copay and no coinsurance for most preventive care, endodontics, periodontics, and oral surgery. Medicare-covered dental services have a $15 copay and no coinsurance, while restorative and fixed prosthodontic services require no copay and a 30% to 40% coinsurance. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HumanaChoice H5525-086 (PPO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance 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, although prior authorization is required.
Medical Equipment See details
HumanaChoice H5525-086 (PPO) covers durable medical equipment and prosthetics with a 20% coinsurance and no copay. Diabetic supplies are covered with 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 services with no coinsurance, featuring no copay for lab services and a copay ranging from $0 to $105 for diagnostic procedures. Covered radiological services include diagnostic radiology and outpatient X-rays with no copay, while therapeutic radiological services require a minimum $30 copay and a minimum 20% coinsurance.
Home Health Services See details
HumanaChoice H5525-086 (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 H5525-086 (PPO) with no coinsurance, though only some services are covered since Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered. These services require prior authorization and have copayments ranging from $10 to $15.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-086 (PPO) covers Skilled Nursing Facility (SNF) care 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, a prior three-day hospital stay is not necessary, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
HumanaChoice H5525-086 (PPO) partially covers other services, offering acupuncture for a $15 copay and no coinsurance, up to 20 treatments per year with prior authorization. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, though meal benefits require prior authorization.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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