HumanaChoice H7617-085 (PPO)

4.5 out of 5 stars
$0.00
Monthly Premium

HumanaChoice H7617-085 (PPO) is a PPO plan offered by Humana Inc.

Plan ID: H7617-085

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 H7617-085 (PPO) - H7617-085 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 $590
Out of Pocket Max In-Network: $4201
Out-of-Network: 8950
Initial Coverage Limit $0
Catastrophic Coverage Limit $2100
Primary Care Doctor Visit

Out-of-Network:

Doctor Office Visit Services:
Copayment for Medicare Covered Primary Care Office Visit $20
Specialty Doctor Visit
In-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $45
Prior Authorization Required for Doctor Specialty Visit
Inpatient Hospital Care

Out-of-Network:

Acute Hospital Services:
Coinsurance for Acute Hospital Services per Stay 35%
Urgent Care

Urgent Care:
Copayment for Urgent Care $50

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $130
Emergency Room Visit

Emergency Care:
Copayment for Emergency Care $130
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 $130
Copayment for Worldwide Emergency Transportation $130
Ambulance Transportation
In-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $335

Air Ambulance:
Coinsurance for Air Ambulance Services $20%
Prior Authorization Required for Air Ambulance

Health Care Services and Medical Supplies

HumanaChoice H7617-085 (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

Out-of-Network:

Chiropractic Services:
Copayment for Medicare Covered Chiropractic Services $55
In-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $15
Prior Authorization Required for Chiropractic Services
Diabetes Supplies, Training, Nutrition Therapy and Monitoring

Out-of-Network:

Diabetic Supplies and Services:
Coinsurance for Medicare Covered Diabetic Supplies 20%
Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 20%
Durable Medical Equipment (DME)

Out-of-Network:

Durable Medical Equipment Services:
Copayment for Medicare Covered Durable Medical Equipment $0
Coinsurance for Medicare Covered Durable Medical Equipment 19%
$0 Continuous Glucose Monitor - DME Prov$0 Continuous Glucose Monitor - Pharmacy19% DME - DME Prov19% DME - Pharmacy
Diagnostic Tests, Lab and Radiology Services, and X-Rays
In-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $75
Copayment for Medicare-covered Lab Services $0 to $50
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
$0 Coumadin Clinic Svcs - OPH$75 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$45 OP Diag Proc & Tests - SPC$50 OP Diag Proc & Tests - UCC$75 Sleep Study (Fac Based) - OPH$45 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $0 to $335
Copayment for Medicare-covered Therapeutic Radiological Services $45
Coinsurance for Medicare-covered Therapeutic Radiological Services 20%
Copayment for Medicare-covered X-Ray Services $0 to $130
Home Health Care

Out-of-Network:

Home Health Services:
Coinsurance for Medicare Covered Home Health 35%
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$262 per day for days 1 to 9
$0 per day for days 10 to 90
Prior Authorization Required for Psychiatric Hospital Services
Mental Health Outpatient Care
In-Network:

Outpatient Mental Health Services:
Copayment for Medicare-covered Individual Sessions $35
Copayment for Medicare-covered Group Sessions $35
Outpatient Services / Surgery

Out-of-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0
Coinsurance for Medicare Covered Outpatient Hospital Services 35%
Copayment for Medicare Covered Ambulatory Surgical Center Services $0
Coinsurance for Medicare Covered Ambulatory Surgical Center Services 35%
$0 Diag Colonoscopy - OPH$35 Mental Health - OPH$350 Surgery Svcs - OPH$45 Wound Care - OPH
Outpatient Substance Abuse Care
In-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $35
Copayment for Medicare-covered Group Sessions $35
Prior Authorization Required for Outpatient Substance Abuse Services

Out-of-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual Sessions $55
Coinsurance for Medicare Covered Individual Sessions 35%
Copayment for Medicare Covered Group Sessions $55
Coinsurance for Medicare Covered Group Sessions 35%
Over-the-counter (OTC) Items
Podiatry Services
In-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $45
Prior Authorization Required for Podiatry Services

Out-of-Network:

Podiatry Services:
Copayment for Medicare Covered Podiatry Services $55
Skilled Nursing Facility Care

Out-of-Network:

Skilled Nursing Facility Services:
Coinsurance for Skilled Nursing Facility per Stay 35%

Dental Benefits

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

Coverage Cost
Dental Care
Plan covers up to $2500 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire.
Your benefit can be used for most dental treatments such as:
Preventive dental services, such as exams, routine cleanings, etc.
Basic dental services, such as fillings, extractions, etc.
Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc.
Frequency limits may apply.
Note: The allowance cannot be used on fluoride, cosmetic services and implants.
Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions.

Vision Benefits

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

Coverage Cost
Vision Benefits
In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0 to $45
Copayment for Routine Eye Exams $0
  • Maximum 1 Routine Eye Exams every year
Prior Authorization Required for Eye Exams
$0 Diab Eye Exam - All POTs$45 Vision Svcs (MC) - SPC

Eyewear:
Copayment for Medicare-Covered Benefits $0
Copayment for Contact Lenses $0
  • Maximum 1 Pair every year
Copayment for Eyeglasses (lenses and frames) $0
  • Maximum 1 Pair every year
Maximum Plan Benefit of $200 every year
Members must use Humana's Medicare Insight Network, a national network of providers, which includes standard or PLUS providers. The allowance for the standard network is $100 less than the PLUS network.

Hearing Benefits

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

Coverage Cost
Hearing Benefits
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $45
Copayment for Routine Hearing Exams $0
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0
Prior Authorization Required for Hearing Exams

Hearing Aids:
Copayment for Hearing Aids $599 to $899
  • Maximum 2 Hearing Aids every year

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 H7617-085 (PPO) plan offers the following prescription drug coverage, with an annual drug deductible of $590 (excludes Tiers 1 and 2) per year.

Coverage Cost
Coverage & Cost
Annual Drug Deductible $590 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $15.00
Generic
  • Preferred cost-share mail order $5.00
  • Standard retail $5.00
  • Standard mail order $20.00
Annual Drug Deductible $590 (excludes Tiers 1 and 2)
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
Annual Drug Deductible $590 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $0.00
  • Standard mail order $45.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $15.00
  • Standard mail order $60.00
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