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Humana Dual Select H5525-046 (PPO D-SNP)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
$31.40
Monthly Premium
Humana Dual Select H5525-046 (PPO D-SNP) is a PPO D-SNP plan offered by Humana Inc.
Plan ID: H5525-046
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 Humana Dual Select H5525-046 (PPO D-SNP) - H5525-046 by Humana Inc. as well as other Medicare Advantage plans available in your area.
$31.40
Monthly Premium
Ohio Counties Served
AdamsAllenAshlandAshtabulaAthensAuglaizeBelmontBrownButlerCarrollChampaignClarkClermontClintonColumbianaCoshoctonCrawfordCuyahogaDarkeDefianceDelawareErieFairfieldFranklinFultonGalliaGeaugaGreeneGuernseyHamiltonHancockHardinHarrisonHenryHighlandHolmesJacksonJeffersonKnoxLakeLawrenceLickingLoganLorainLucasMadisonMahoningMarionMedinaMeigsMiamiMonroeMontgomeryMorganMorrowMuskingumNobleOttawaPauldingPerryPickawayPortagePreblePutnamRossSanduskySciotoSenecaShelbyStarkSummitTrumbullTuscarawasUnionVan WertVintonWarrenWashingtonWayneWilliamsWoodWyandot
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $615 |
| Out of Pocket Max |
In-Network: $9250 Out-of-Network: 13900 |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $2100 |
| Primary Care Doctor Visit | Out-of-Network: Doctor Office Visit Services: Coinsurance for Medicare Covered Primary Care Office Visit $0% or$ 20% |
| Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Coinsurance for Physician Specialist Office Visit $0% or$ 20% Prior Authorization Required for Doctor Specialty Visit |
| Inpatient Hospital Care | In-Network: Acute Hospital Services: Copayment for Acute Hospital Services per Stay $0 or $2230 Prior Authorization Required for Acute Hospital Services |
| Urgent Care | Urgent Care: Coinsurance for Urgent Care 0% or 20% Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 or $115 |
| Emergency Room Visit | Emergency Care: Copayment for Emergency Care $0 or $115 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 $0 or $115 Copayment for Worldwide Emergency Transportation $0 or $115 |
| Ambulance Transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $0 or $335 Air Ambulance: Copayment for Air Ambulance Services $0 or $335 Prior Authorization Required for Air Ambulance |
Health Care Services and Medical Supplies
Humana Dual Select H5525-046 (PPO D-SNP) 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 $0 or $15 Prior Authorization Required for Chiropractic Services Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 0% or 20% |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Diabetic Supplies and Services: Copayment for Medicare-covered Diabetic Supplies $0 or 0 Coinsurance for Medicare-covered Diabetic Supplies 0 or 20% Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0 |
| Durable Medical Equipment (DME) | Out-of-Network: Durable Medical Equipment Services: Copayment for Medicare Covered Durable Medical Equipment $0 or 0 Coinsurance for Medicare Covered Durable Medical Equipment 0 or 20% $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: Coinsurance for Medicare Covered Diagnostic Procedures/Tests 0% or 20% Coinsurance for Medicare Covered Lab Services 0% or 20% Copayment for Medicare Covered Diagnostic Radiological Services $0 or 0 to $335 Coinsurance for Medicare Covered Diagnostic Radiological Services 0 or 20% Coinsurance for Medicare Covered Therapeutic Radiological Services 0% or 20% Copayment for Medicare Covered Outpatient X-Ray Services $0 or $50 Coinsurance for Medicare Covered Outpatient X-Ray Services 0 or 20% 20% OP Diag Proc & Tests - OPH20% OP Diag Proc & Tests - PCP20% OP Diag Proc & Tests - SPC20% OP Diag Proc & Tests - UCC20% Sleep Study (Fac Based) - OPH20% Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home |
| Home Health Care | Out-of-Network: Home Health Services: Copayment for Medicare Covered Home Health $0 |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0 or $2080 Prior Authorization Required for Psychiatric Hospital Services |
| Mental Health Outpatient Care | In-Network: Outpatient Mental Health Services: Copayment for Medicare-covered Individual Sessions $0 or $35 Copayment for Medicare-covered Group Sessions $0 or $35 |
| Outpatient Services / Surgery | Out-of-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 or 0 to $35 Coinsurance for Medicare Covered Outpatient Hospital Services 0 or 20% Copayment for Medicare Covered Ambulatory Surgical Center Services $0 or 0 Coinsurance for Medicare Covered Ambulatory Surgical Center Services 0 or 20% $0 Diag Colonoscopy - OPH$35 Mental Health - OPH20% Surgery Svcs - OPH20% Wound Care - OPH |
| Outpatient Substance Abuse Care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $0 or $35 Copayment for Medicare-covered Group Sessions $0 or $35 Prior Authorization Required for Outpatient Substance Abuse Services Out-of-Network: Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $0 or $35 Copayment for Medicare Covered Group Sessions $0 or $35 |
| Over-the-counter (OTC) Items | Healthy Options Allowance: $85 monthly allowance on a prepaid spending card. All plan members receive this amount to buy approved over the counter (OTC) health and wellness products at participating retailers. Plus, members may also use this money for eligible groceries, utilities, rent, and more if they have certain qualifying chronic condition(s) and meet other program criteria. Any unused amount rolls over each month and expires at the end of the plan year or upon disenrollment, whichever occurs first. |
| Podiatry Services | In-Network: Podiatry Services: Coinsurance for Medicare-Covered Podiatry Services 0% or 20% Prior Authorization Required for Podiatry Services Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 0% or 20% |
| Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $218 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | $0 copayment for gingivectomy, scaling and root planing (deep cleaning) up to 1 per quadrant every 3 years. $0 copayment for periodontal surgery, sealant up to 1 per tooth every 3 years. $0 copayment for 3D scans, comprehensive oral exam, occlusal adjustment, occlusal guard, scaling for moderate inflammation up to 1 every 3 years. $0 copayment for alveoloplasty in conjunction with extractions up to 1 per quadrant every 5 years. Only covered in conjunction with the construction of a prosthodontic appliance. $0 copayment for complete dentures, cone beam CT imaging, crown recementation, panoramic film or diagnostic x-rays, partial dentures up to 1 every 5 years. $0 copayment for other preventive services up to 1 per tooth every 6 months. $0 copayment for orthodontic retention, space maintainer up to 1 per arch per lifetime. $0 copayment per tooth for crown, endodontic services, oral surgery, removal of impacted tooth, root canal, root canal retreatment, therapeutic pulpotomy up to 1 per lifetime. $0 copayment for comprehensive orthodontic, harmful habit appliance, implant services, maxillofacial prosthetics, non-clinical procedures, other orthodontic, sleep apnea, temporomandibular disorder (TMD) up to 1 per lifetime. $0 copayment for parenteral medications up to 1 per visit. $0 copayment for other restorative services - core buildup and prefabricated post and core up to 1 per tooth per year. $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, extra-oral x-rays, other diagnostic services, other diagnostic x-rays, periodontal exam, tissue conditioning up to 1 per year. $0 copayment for other restorative services up to 2 per tooth per year. $0 copayment for counseling services, emergency treatment for pain, fluoride, oral surgery, periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for caries medicament up to 3 per tooth per year. $0 copayment for periodic orthodontic, 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 up to unlimited per year. $0 copayment for extractions up to unlimited. $500 maximum benefit coverage amount per year for all diagnostic/preventive and comprehensive benefits. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. For certain services, coverage is limited to members younger than 21 |
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 or 0 Coinsurance for Medicare Covered Benefits 0 or 20% Copayment for Routine Eye Exams $0
$0 Diab Eye Exam - All POTs20% Vision Svcs (MC) - SPC Eyewear: Coinsurance for Medicare-Covered Benefits 0% or 20% Copayment for Contact Lenses $0
Maximum Plan Benefit of $1,400 (Please see Evidence of Coverage for details) |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | Out-of-Network: Hearing Exams Services: Coinsurance for Medicare Covered Hearing Exams 0% or 20% |
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:
Yearly "Wellness" visit |
Prescription Drug Costs and Coverage
The Humana Dual Select H5525-046 (PPO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $615 (excludes Tiers 1 and 2) per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|
| Annual Drug Deductible | $615 (excludes Tiers 1 and 2) |
| Preferred Generic |
|
| Generic |
|