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HumanaChoice Florida H7284-001 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice Florida H7284-001 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice Florida H7284-001 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice Florida H7284-001 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Lake, Marion, Seminole and Sumter counties. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that HumanaChoice Florida H7284-001 (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 Florida H7284-001 (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 Florida H7284-001 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $73.00. 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 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 $5100.00 (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 $5100.00 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 Florida H7284-001 (PPO) plan has no deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies, while standard generic drugs have a $47 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy (LIS), your monthly premium will be reduced from $24.90 to $4.60. Please check the plan's formulary for specific drugs covered.
Additional Benefits
The HumanaChoice Florida H7284-001 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $125 copay for the first 10 days, and no copay thereafter, while outpatient services have copays that vary by service. Emergency services have a $140 copay, and primary care visits are covered with no copay. This plan also includes coverage for preventive services with no copay, and hearing, vision, and dental services with copays that vary. Additional benefits include home health services with no copay, and skilled nursing facility services with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital services include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you will pay a $125 copay for days 1-10, and no copay for days 11-90, while additional days (91-999) have no copay. For Inpatient Hospital Psychiatric, you will pay a $125 copay for days 1-10, and no copay for days 11-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient substance abuse services are covered. Outpatient hospital services have a copay between $0 and $125, and observation services have a copay of $125. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Individual and Group sessions for Outpatient Substance Abuse have a copay between $20 and $50.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice Florida H7284-001 (PPO) plan, with a $20 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a copay of $120-$240, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered. Emergency Services have a $140 copay, and Urgently Needed Services have a $15 copay. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
The HumanaChoice Florida H7284-001 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $5 copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $5 copay. This plan also covers mental health and psychiatric services with a copay of $20, and additional telehealth benefits with a copay between $0 and $20.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, and other services such as Glaucoma Screenings, Diabetes Self-Management Training, and Barium Enemas with no copay. In-Home Support Services and Fitness Benefit are also covered with no copay.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered up to $1000 every three years, and OTC hearing aids are covered with no copay, up to $1000 every three years. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The HumanaChoice Florida H7284-001 (PPO) plan covers vision services, including eye exams with a copay between $0 and $20, and eyewear with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan offers a combined maximum of $200 for all eyewear annually.
Dental Services See details
The HumanaChoice Florida H7284-001 (PPO) plan covers Medicare Dental Services with a $20 copay, and other dental services are covered up to a maximum of $1,000 per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no coinsurance. Fluoride treatment, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered. Restorative services and periodontics have a $25 copay.
Home Infusion bundled Services See details
The HumanaChoice Florida H7284-001 (PPO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with a 20% coinsurance and no copay for Medicare-covered devices and supplies, and Diabetic Equipment. The plan covers Diabetic Supplies with a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures/tests have a copay between $0 and $125, lab services have no copay, diagnostic radiological services have a copay up to $125, therapeutic radiological services have a copay between $20 and $50, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice Florida H7284-001 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the HumanaChoice Florida H7284-001 (PPO) plan, but all sub-services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice Florida H7284-001 (PPO), with no copay for days 1-20, and a $160 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. Over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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