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HumanaChoice H5970-028 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5970-028 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5970-028 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5970-028 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in New York City. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that HumanaChoice H5970-028 (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 H5970-028 (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 H5970-028 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan has a $25.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 $13900.00 (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 $13900.00 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 H5970-028 (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost as little as a $5 copay for a 1-month supply, 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 medications, you will pay coinsurance, which includes a 35% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. These structured costs help you easily plan your healthcare budget for your specific medication needs.
Additional Benefits
The HumanaChoice H5970-028 (PPO) plan offers robust coverage for essential medical needs, featuring no copay for primary care visits and a $40 copay for specialists. Inpatient hospital stays require a $360 daily copay for the first seven days with no copay thereafter, while outpatient hospital services range from no copay up to an $850 copay. Emergency room visits carry a $115 copay, which is waived upon admission, and urgent care services are available with a $40 copay. For supplemental care, members benefit from no copay for preventive and comprehensive dental services, routine vision exams, and routine hearing exams. Prescription hearing aids are covered with copays between $699 and $999, while durable medical equipment requires a 16% coinsurance with no copay. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
HumanaChoice H5970-028 (PPO) covers inpatient acute hospital stays with no coinsurance and a $360 daily copay for days 1 to 7 (with no copay for days 8 and beyond), and inpatient psychiatric care with no coinsurance and a $276 daily copay for days 1 to 7 (with no copay for days 8 to 90). Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
HumanaChoice H5970-028 (PPO) covers outpatient services with no coinsurance, although prior authorization is required for most services. Ambulatory surgical center and outpatient blood services feature no copay, outpatient substance abuse sessions have a $35 copay, and outpatient hospital services carry a copay of $0 to $850, with observation services costing $360 per stay.
Partial Hospitalization See details
HumanaChoice H5970-028 (PPO) covers partial hospitalization with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5970-028 (PPO) covers Medicare-approved ground and air ambulance services with a $310 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered under HumanaChoice H5970-028 (PPO) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require 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 H5970-028 (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, speech, and mental health therapies require a $35 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services under HumanaChoice H5970-028 (PPO) are partially covered with no copay and no coinsurance for annual physicals, kidney disease education, and memory fitness. Non-covered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, nutritional benefits, palliative care, and caregiver support.
Hearing Services See details
HumanaChoice H5970-028 (PPO) covers Medicare-covered hearing exams with a $40 copay and no coinsurance, while routine hearing exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $699 to $999 and no coinsurance for up to two aids per year, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice H5970-028 (PPO) partially covers vision services with no copay, no coinsurance, and no deductible for covered routine exams and select eyewear, providing up to a $75 annual limit for exams and a $200 yearly limit for contacts or eyeglasses. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5970-028 (PPO), offering Medicare-covered dental care for a $40 copay and no coinsurance, and preventive and comprehensive care with no copay and no coinsurance. However, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice H5970-028 (PPO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%, while chemotherapy and other Part B drugs have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
HumanaChoice H5970-028 (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
HumanaChoice H5970-028 (PPO) covers durable medical equipment (DME) with a 16% coinsurance and no copay, and prosthetic devices and medical supplies with a 20% coinsurance. 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
Diagnostic and radiological services are covered by HumanaChoice H5970-028 (PPO), offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests range from a $0 to $90 copay with no coinsurance, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HumanaChoice H5970-028 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HumanaChoice H5970-028 (PPO) with no copay and no coinsurance, though some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5970-028 (PPO) with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not necessary, though additional days beyond the standard 100-day limit are not covered.
Other Services See details
HumanaChoice H5970-028 (PPO) provides partial coverage for other services, featuring acupuncture with a $40 copay and no coinsurance for up to 20 treatments yearly, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered services, while over-the-counter (OTC) items are not covered.
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