HumanaChoice H7617-018 (PPO)

4.5 out of 5 stars
$0.00
Monthly Premium

HumanaChoice H7617-018 (PPO) is a PPO plan offered by Humana Inc.

Plan ID: H7617-018

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.


Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.

Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.

Learn more about Medicare Advantage plans such as HumanaChoice H7617-018 (PPO) - H7617-018 by Humana Inc. as well as other Medicare Advantage plans available in your area.

$0.00
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $615
Out of Pocket Max In-Network: $3600
Out-of-Network: 6300
Initial Coverage Limit $0
Catastrophic Coverage Limit $2100
Primary Care Doctor Visit
In-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0
Specialty Doctor Visit

Out-of-Network:

Doctor Specialty Visit Services:
Copayment for Medicare Covered Physician Specialist Office Visit $50
Inpatient Hospital Care

Out-of-Network:

Acute Hospital Services:
Coinsurance for Acute Hospital Services per Stay 50%
Urgent Care

Urgent Care:
Copayment for Urgent Care $65

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $150
Emergency Room Visit

Emergency Care:
Copayment for Emergency Care $150
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $150
Copayment for Worldwide Emergency Transportation $150
Ambulance Transportation

Out-of-Network:

Ambulance Services:
Copayment for Medicare Covered Ambulance Services - Ground $335
Coinsurance for Medicare Covered Ambulance Services - Air $20%

Health Care Services and Medical Supplies

HumanaChoice H7617-018 (PPO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage Cost
Chiropractic Services
In-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $20
Prior Authorization Required for Chiropractic Services

Out-of-Network:

Chiropractic Services:
Copayment for Medicare Covered Chiropractic Services $50
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network:

Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0
Coinsurance for Medicare-covered Diabetic Supplies 10% to 20%
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $10
Durable Medical Equipment (DME)
In-Network:

Durable Medical Equipment:
Copayment for Medicare-covered Durable Medical Equipment $0
Coinsurance for Medicare-covered Durable Medical Equipment 20%
Prior Authorization Required for Durable Medical Equipment
$0 Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy20% DME - DME Prov20% DME - Pharmacy
Diagnostic Tests, Lab and Radiology Services, and X-Rays

Out-of-Network:

Diagnostic Procedures/Tests Services:
Copayment for Medicare Covered Diagnostic Procedures/Tests
$30 to $50
Coinsurance for Medicare Covered Diagnostic Procedures/Tests
50%
Copayment for Medicare Covered Lab Services
$30 to $50
Coinsurance for Medicare Covered Lab Services
50%
Copayment for Medicare Covered Diagnostic Radiological Services $0
Coinsurance for Medicare Covered Diagnostic Radiological Services 50%
Coinsurance for Medicare Covered Therapeutic Radiological Services 50%
Copayment for Medicare Covered Outpatient X-Ray Services $30 to $50
Coinsurance for Medicare Covered Outpatient X-Ray Services 50%
$95 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$25 OP Diag Proc & Tests - SPC$65 OP Diag Proc & Tests - UCC$95 Sleep Study (Fac Based) - OPH$25 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home
Home Health Care
In-Network:

Home Health Services:
Copayment for Medicare-covered Home Health Services $0
Prior Authorization Required for Home Health Services
Mental Health Inpatient Care

Out-of-Network:

Psychiatric Hospital Services:
Coinsurance for Psychiatric Hospital per Stay 50%
Mental Health Outpatient Care

Out-of-Network:

Mental Health Services:
Copayment for Medicare Covered Individual Sessions $50
Copayment for Medicare Covered Group Sessions $50
Outpatient Services / Surgery

Out-of-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0
Coinsurance for Medicare Covered Outpatient Hospital Services 50%
Copayment for Medicare Covered Ambulatory Surgical Center Services $0
Coinsurance for Medicare Covered Ambulatory Surgical Center Services 50%
$0 Diag Colonoscopy - OPH$35 Mental Health - OPH$300 Surgery Svcs - OPH$25 Wound Care - OPH
Outpatient Substance Abuse Care
In-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $20 to $35
Copayment for Medicare-covered Group Sessions $20 to $35
Prior Authorization Required for Outpatient Substance Abuse Services
$35 OP Substance Abuse Care - OPH$20 OP Substance Abuse Care - SPC

Out-of-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual Sessions $50
Coinsurance for Medicare Covered Individual Sessions 50%
Copayment for Medicare Covered Group Sessions $50
Coinsurance for Medicare Covered Group Sessions 50%
$35 OP Substance Abuse Care - OPH$20 OP Substance Abuse Care - SPC
Over-the-counter (OTC) Items
Over-the-Counter: $50 quarterly allowance to buy approved over-the-counter health and wellness products available through our OTC Mail Order provider.
Unused amount rolls over to the next quarter and expires at the end of the plan year.
Podiatry Services
In-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $25
Prior Authorization Required for Podiatry Services

Out-of-Network:

Podiatry Services:
Copayment for Medicare Covered Podiatry Services $50
Skilled Nursing Facility Care

Out-of-Network:

Skilled Nursing Facility Services:
Coinsurance for Skilled Nursing Facility per Stay 50%

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
$0 copayment for scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years.
$0 copayment for comprehensive oral evaluation or periodontal exam, occlusal adjustment, scaling for moderate inflammation up to 1 every 3 years.
$0 copayment for bridge recementation, crown recementation, panoramic film or diagnostic x-rays up to 1 every 5 years.
$0 copayment for crown, other restorative services - core buildup and prefabricated post and core, root canal, root canal retreatment up to 1 per tooth per lifetime.
$0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year.
$0 copayment for adjustments to dentures, denture rebase, denture reline, denture repair, emergency diagnostic exam, tissue conditioning up to 1 per year.
$0 copayment for emergency treatment for pain, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year.
$0 copayment for periodontal maintenance up to 4 per year.
$0 copayment for necessary anesthesia with covered service up to as needed with covered codes per year.
$0 copayment for amalgam and/or composite filling, simple or surgical extraction up to unlimited per year.
30% coinsurance for bridges-pontic, complete dentures, partial dentures up to 1 every 5 years.
30% coinsurance for bridges-crown up to 2 every 5 years.
$3,000 combined maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits.

Vision Benefits

The following vision services are covered from in-network providers.

Coverage Cost
Vision Benefits

Out-of-Network:

Eye Exams Services:
Copayment for Medicare Covered Eye Exams $50
Coinsurance for Medicare Covered Eye Exams 50%
Copayment for Medicare Covered Eyewear $0
$0 Diab Eye Exam - All POTs$25 Vision Svcs (MC) - SPC

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits

Out-of-Network:

Hearing Exams Services:
Copayment for Medicare Covered Hearing Exams $50

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage Cost
Preventive Services and Health/Wellness Education Programs
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
Tobacco use cessation
Yearly "Wellness" visit

Prescription Drug Costs and Coverage

The HumanaChoice H7617-018 (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $615 (excludes Tiers 1, 2 and 3) per year.

Coverage Cost
Coverage & Cost
Annual Drug Deductible $615 (excludes Tiers 1, 2 and 3)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $10.00
Generic
  • Preferred cost-share mail order $10.00
  • Standard retail $10.00
  • Standard mail order $20.00
Preferred Brand
  • Preferred cost-share mail order $47.00
  • Standard retail $47.00
  • Standard mail order $47.00
Annual Drug Deductible $615 (excludes Tiers 1, 2 and 3)
Preferred Generic
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
Generic
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
Preferred Brand
  • Preferred cost-share mail order N/A
  • Standard retail N/A
  • Standard mail order N/A
Annual Drug Deductible $615 (excludes Tiers 1, 2 and 3)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $30.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $30.00
  • Standard mail order $60.00
Preferred Brand
  • Preferred cost-share mail order $131.00
  • Standard retail $141.00
  • Standard mail order $141.00
Back to Plans in Illinois