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HumanaChoice H7617-019 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H7617-019 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H7617-019 (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
HumanaChoice H7617-019 (PPO) is a PPO plan offered by Emphesys Insurance Company available for the 2026 plan year to people living in Select Counties in WA. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H7617-019 (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 H7617-019 (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 H7617-019 (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 $350.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7050.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7050.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $13900.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 H7617-019 (PPO) Medicare plan features an annual prescription drug deductible of $350. For Tier 1 preferred generic drugs, there is no copay when using standard pharmacies or preferred mail order services. Tier 2 generic drugs cost a $12 copay for a one-month supply at standard pharmacies, but you can get a three-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with three-month supplies costing $131 through preferred mail order. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 37% coinsurance. Specialty drugs in Tier 5 carry a 29% coinsurance for a one-month supply across standard pharmacies and mail order services.
Additional Benefits
HumanaChoice H7617-019 (PPO) offers comprehensive medical coverage featuring no copays and no coinsurance for primary care visits, home health services, and routine diagnostic lab tests. For specialized care, members pay predictable copays with no coinsurance, such as $40 for specialist visits, $115 for emergency room care, and daily copays for the first four days of inpatient hospital stays. The plan also provides robust supplemental benefits, including dental coverage up to a $3,500 annual limit and routine vision and hearing exams with no copays, deductibles, or coinsurance. Other essential services like durable medical equipment and dialysis require no copay but carry a 20% coinsurance, while prescription hearing aids require copays ranging from $699 to $999.
Inpatient Hospital See details
HumanaChoice H7617-019 (PPO) covers inpatient hospital services with no coinsurance, requiring a $597 daily copay for days 1-4 of acute stays and a $505 daily copay for days 1-4 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and some services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H7617-019 (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which both feature no copays. Medicare-covered outpatient hospital services have a copay ranging from $0 to $400 ($597 per stay for observation services), while outpatient substance abuse sessions have a copay of $0 to $35.
Partial Hospitalization See details
Partial hospitalization is covered by the HumanaChoice H7617-019 (PPO) plan 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 partially covered by HumanaChoice H7617-019 (PPO), with ambulance services requiring prior authorization, no coinsurance, and a copay of $335 for ground transport and $1,250 for air transport. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H7617-019 (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with 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 H7617-019 (PPO) covers primary care physician, mental health, and psychiatric services with no copay and no coinsurance. Specialist visits require a $40 copay with no coinsurance, and physical, occupational, and speech therapies have a $35 copay with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HumanaChoice H7617-019 (PPO) features partially covered preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, and a memory fitness benefit. However, several additional preventive services are not covered, including health education, nutritional/dietary benefits, weight management programs, and in-home safety assessments.
Hearing Services See details
HumanaChoice H7617-019 (PPO) hearing services are partially covered with no deductible, featuring no copay and no coinsurance for annual routine exams, fitting evaluations, and unlimited OTC hearing aids. Medicare-covered exams require a $40 copay and no coinsurance, while prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Vision services are partially covered by HumanaChoice H7617-019 (PPO), featuring no copay, no coinsurance, and no deductible for routine eye exams and eyewear, with annual limits of $75 for exams and $250 for glasses or contacts. Prior authorization is required, and non-covered services include other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
HumanaChoice H7617-019 (PPO) offers partially covered dental services with an annual maximum benefit of $3,500 for combined in-network and out-of-network care. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance; however, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H7617-019 (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while covered Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H7617-019 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H7617-019 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, though prior authorization is required. Diabetic supplies are covered with no copay and a 10% to 20% coinsurance from select manufacturers, while diabetic therapeutic shoes or inserts carry a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
HumanaChoice H7617-019 (PPO) covers diagnostic and radiological services with no coinsurance for diagnostic services, no copay for lab services and outpatient X-rays, and a $0 to $50 copay for diagnostic procedures. Diagnostic radiological services carry a minimum $0 copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
HumanaChoice H7617-019 (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H7617-019 (PPO) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are all excluded. If utilized, these services require prior authorization and carry a $10 copay with no coinsurance.
Skilled Nursing Facility (SNF) See details
HumanaChoice H7617-019 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but not requiring a prior three-day hospital stay. Patients pay no copay for days 1 to 20 and days 86 to 100, a $218 daily copay for days 21 to 85, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HumanaChoice H7617-019 (PPO) partially covers other services, offering acupuncture with a $40 copay and no coinsurance for up to 20 treatments yearly, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while other miscellaneous services under this category are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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