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Humana Full Access H7617-055 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Full Access H7617-055 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Full Access H7617-055 (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.
Humana Full Access H7617-055 (PPO) is a PPO plan offered by Emphesys Insurance Company available for the 2026 plan year to people living in Macomb, Oakland and Wayne counties. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Full Access H7617-055 (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 Humana Full Access H7617-055 (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 Humana Full Access H7617-055 (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. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 $4800.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4800.00 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 $4800.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $4800.00 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 Humana Full Access H7617-055 (PPO) Medicare plan features an annual drug deductible of $350. Under this plan, Tier 1 preferred generic drugs have 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, starting with a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, and no copay for a 3-month supply through preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, with a slightly reduced $131 copay for a 3-month supply through preferred mail order. Tier 4 non-preferred drugs require a 47% coinsurance across all pharmacy and mail order options, while Tier 5 specialty drugs carry a 29% coinsurance for a 1-month supply.
Additional Benefits
The Humana Full Access H7617-055 (PPO) plan offers robust medical coverage with no copay for primary care visits and preventive services, while specialist visits require a $40 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, and outpatient hospital services feature copays ranging from no copay up to $440. For inpatient hospital stays, members pay a $440 daily copay for the first few days of care with no coinsurance. Routine vision, hearing, and home health services are available with no copay, while dental care is covered up to a $2,500 annual limit with no copay for most preventive and comprehensive services. High-value medical needs such as durable medical equipment and dialysis require a 20% coinsurance with no copay. Additionally, the plan includes convenient benefits like covered over-the-counter items and up to 24 one-way transportation trips per year with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Humana Full Access H7617-055 (PPO) with no coinsurance, requiring a $440 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for remaining days. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Full Access H7617-055 (PPO) covers outpatient services with no coinsurance, although prior authorization is required for most services. Outpatient hospital copays range from $0 to $440, observation services require a $440 copay per stay, outpatient substance abuse sessions cost a $35 copay, and ambulatory surgical center and blood services are available with no copay.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Full Access H7617-055 (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Humana Full Access H7617-055 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance per trip. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Full Access H7617-055 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available for a $130 copay per service and no coinsurance.
Primary Care See details
Humana Full Access H7617-055 (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapy services have a $10 to $45 copay with no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Humana Full Access H7617-055 (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional benefits are partially covered, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Full Access H7617-055 (PPO) covers hearing services with no deductible, offering routine hearing exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Medicare-covered exams require a $40 copay and no coinsurance, while prescription hearing aids are partially covered with a $399 to $999 copay and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Full Access H7617-055 (PPO) partially covers vision services with no deductibles and no coinsurance, offering covered services with no copay. This includes one routine eye exam (up to $40 annually) and one pair of contact lenses or eyeglasses (up to a $400 annual limit), while other eye exams, separate eyeglass lenses or frames, and upgrades are not covered.
Dental Services See details
Humana Full Access H7617-055 (PPO) features partially covered dental services with a $2,500 annual maximum, offering Medicare-covered dental with a $40 copay and no coinsurance, and other covered services with no copay and no coinsurance. While many preventive and comprehensive services are covered, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Full Access H7617-055 (PPO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B drugs, including chemotherapy and other medications, require a 0% to 20% coinsurance, while covered insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Full Access H7617-055 (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Full Access H7617-055 (PPO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay, with prior authorization required for most items.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Humana Full Access H7617-055 (PPO) with prior authorization, featuring no copays for lab services, outpatient X-rays, and diagnostic radiological services. Diagnostic procedures and tests carry a copay of $0 to $105 and a 20% coinsurance, while therapeutic radiological services require a $40 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Full Access H7617-055 (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Humana Full Access H7617-055 (PPO) covers some cardiac rehabilitation services with no coinsurance, subject to prior authorization. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a $10.00 copay.
Skilled Nursing Facility (SNF) See details
Humana Full Access H7617-055 (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and although a prior three-day inpatient hospital stay is not needed, additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Humana Full Access H7617-055 (PPO) covers acupuncture with a $40 copay and no coinsurance for up to 20 treatments annually, and a home meal benefit with no copay and no coinsurance, both requiring prior authorization. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance via reimbursement, though certain drugs on the CMS OTC list are excluded.
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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