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HumanaChoice H7617-004 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H7617-004 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H7617-004 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H7617-004 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in Ohio & N KY. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H7617-004 (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 H7617-004 (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 H7617-004 (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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $250.00 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 $9600.00 (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 $9600.00 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 H7617-004 (PPO) Medicare plan features an annual prescription drug deductible of $250. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply when filled at standard pharmacies or through preferred mail order. Tier 2 generic drugs require a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, and there is no copay for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, with a 3-month supply costing $131 through preferred mail order and $141 through standard options. For higher-tier prescriptions, you will pay a coinsurance rather than a flat copay, which includes a 48% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply across standard pharmacies and mail order services.
Additional Benefits
The HumanaChoice H7617-004 (PPO) plan offers comprehensive medical coverage with no copays or coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $40 copay, while emergency room visits carry a $130 copay, both with no coinsurance. For inpatient hospital stays, members pay a $495 daily copay for the first five days of acute stays and no copay for the remaining covered days. Ancillary benefits include vision care with no copay and up to $350 annually for eyewear, alongside dental coverage featuring a $1,500 annual limit and no copays for most covered dental services. Routine hearing exams and over-the-counter hearing aids are also available with no copay, while prescription hearing aids require a copay between $699 and $999. Major medical needs, such as durable medical equipment and dialysis services, generally require a 20% coinsurance with no copay.
Inpatient Hospital See details
HumanaChoice H7617-004 (PPO) covers inpatient hospital services with no coinsurance, requiring a $495 daily copay for days 1 to 5 of acute stays and days 1 to 4 of psychiatric stays, followed by no copay for remaining covered days. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H7617-004 (PPO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical centers and outpatient blood services. Outpatient hospital services require a copay of $0 to $500, observation services require a $495 copay per stay, and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
HumanaChoice H7617-004 (PPO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HumanaChoice H7617-004 (PPO), which features a $335 copay and no coinsurance for ground and air ambulance services. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
HumanaChoice H7617-004 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H7617-004 (PPO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Other covered services, including physical therapy, mental health, and telehealth, require copays ranging from $0 to $50 with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice H7617-004 (PPO) with no copay and no coinsurance, including annual physical exams and diabetes training. Additional preventive benefits are partially covered, but sub-services such as health education, weight management, in-home support, and alternative therapies are not covered. Covered supplemental benefits include memory fitness and chemotherapy wigs, which have no copay and a $500 annual limit.
Hearing Services See details
HumanaChoice H7617-004 (PPO) hearing services include Medicare-covered exams for a $40 copay and no coinsurance, alongside routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HumanaChoice H7617-004 (PPO) with no copay, no coinsurance, and no deductible for one routine eye exam per year and up to $350 annually for eyewear, which covers one pair of contact lenses or eyeglasses (lenses and frames). Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H7617-004 (PPO) partially covers dental services up to a $1,500 annual maximum for both in-network and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered dental services have no copay and no coinsurance, excluding fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics which are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by HumanaChoice H7617-004 (PPO) with no copay, though prior authorization is required. Related Medicare Part B chemotherapy, insulin, and other drugs are covered with coinsurance ranging from no coinsurance up to 20%, with insulin drugs carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H7617-004 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H7617-004 (PPO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies have a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H7617-004 (PPO) with prior authorization, featuring no coinsurance alongside no copay for lab services and a copay ranging from no copay to $105 for diagnostic tests. Radiological services include outpatient X-rays and diagnostic radiology starting at no copay, while therapeutic radiology requires a minimum 20% coinsurance and a $50 copay.
Home Health Services See details
Home health services are covered under the HumanaChoice H7617-004 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
HumanaChoice H7617-004 (PPO) covers Cardiac Rehabilitation Services with a $15 copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for symptomatic peripheral artery disease rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H7617-004 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
HumanaChoice H7617-004 (PPO) covers acupuncture with a $40 copay and no coinsurance, limited to 20 treatments per year. Over-the-counter items and meal benefits for chronic illness are covered with no copay and no coinsurance, while other additional services are not covered.
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