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HumanaChoice H5970-029 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5970-029 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5970-029 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5970-029 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in New York. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that HumanaChoice H5970-029 (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 H5970-029 (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 H5970-029 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.00. 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 $13500.00 (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 $13500.00 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 H5970-029 (PPO) Medicare 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 are also highly affordable, costing a $5 copay for a 1-month supply, or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail-order options, with a discounted $131 copay for a 3-month supply through preferred mail order. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 39% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance across all fulfillment options.
Additional Benefits
The HumanaChoice H5970-029 (PPO) plan offers affordable access to essential medical services, featuring no copays or coinsurance for primary care visits and routine preventive care. Specialist visits require a $40 copay, while emergency room visits have a $115 copay that is waived if you are admitted. For inpatient hospital stays, members pay a daily copay of $380 for days one through seven of acute care, with no copay or coinsurance required for day eight and beyond. This plan also includes strong supplemental coverage, providing routine vision and hearing exams with no copays and partially covered dental services up to a $2,000 annual limit. Home health services are available with no copay, while durable medical equipment and dialysis services carry an 18% to 20% coinsurance with no copay. Additionally, diagnostic labs and outpatient X-rays are covered with no copay, helping keep your out-of-pocket costs predictable.
Inpatient Hospital See details
HumanaChoice H5970-029 (PPO) covers inpatient hospital services with no coinsurance, requiring a $380 copay per day for days 1 through 7 (no copay for days 8 and beyond) for acute care, and a $290 copay per day for days 1 through 7 (no copay for days 8 through 90) for psychiatric care. Non-Medicare-covered stays, psychiatric additional days, and hospital upgrades are not covered, and prior authorization is required.
Outpatient Services See details
HumanaChoice H5970-029 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, a $35 copay for outpatient substance abuse sessions, and copays ranging from no copay up to $850 for outpatient hospital and observation services. Prior authorization is required for most of these covered outpatient services.
Partial Hospitalization See details
HumanaChoice H5970-029 (PPO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HumanaChoice H5970-029 (PPO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance per trip, and prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Emergency services under the HumanaChoice H5970-029 (PPO) plan are covered 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 H5970-029 (PPO) features primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Other covered services, including physical, occupational, psychiatric, and mental health therapies, have a $35 copay and no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice H5970-029 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and select screenings. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
HumanaChoice H5970-029 (PPO) covers hearing exams with a $40 copay for Medicare-covered exams and no copay for routine yearly exams or fitting evaluations, all with no deductible or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $299 for up to two devices every three years, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H5970-029 (PPO), featuring no deductibles, no coinsurance, and no copays for one annual routine eye exam and select eyewear like contact lenses or eyeglasses. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
HumanaChoice H5970-029 (PPO) offers partially covered dental services with an annual maximum benefit of $2,000 for both in-network and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered services have no copay and no coinsurance. Fluoride, removable prosthodontics, implants, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice H5970-029 (PPO) with no copay and no coinsurance, subject to prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HumanaChoice H5970-029 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5970-029 (PPO) covers durable medical equipment (DME) with an 18% coinsurance and no copay, and prosthetics and medical supplies with a 20% coinsurance and no copay. Diabetic supplies from specified manufacturers are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5970-029 (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and tests have no coinsurance and a copay of $0 to $300, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by HumanaChoice H5970-029 (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HumanaChoice H5970-029 (PPO) indicates that some services are covered for Cardiac Rehabilitation Services with no coinsurance, though cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. These services require prior authorization and carry copayments ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5970-029 (PPO) 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, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the standard 100-day Medicare-covered period are not covered.
Other Services See details
HumanaChoice H5970-029 (PPO) provides partial coverage for other services, featuring acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, alongside chronic illness meal benefits with no copay and no coinsurance. Both of these covered benefits require prior authorization, while over-the-counter (OTC) items are not covered.
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