In-network
Inpatient hospital
Days 1–7 $375 / day
Days 8–90 $0 / day
Total of listed copays · 7 charged days $2,625
Out-of-network
Tier 1: 50% coinsurance
Point of service
Not separately reported
● CMS 2027 plan record
HumanaChoice Giveback H5525-035 (PPO)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network$325 copay
Air · in-network20% coinsurance
Emergency services
Emergency room
$115 copay
Waived if admitted within 24 hours
Medical maximum
Maximum out-of-pocket
In-network$9,850
Combined in + out$14,800
Skilled care at home
Home health
In-network$0 copay
Out-of-network50% coinsurance
Monthly cost
Premium & giveback
Part C premium$0 / month
Consolidated C + D$0 / month
CMS reports a Part B premium reduction of $110 per month.
Quick view
Primary care physician
In: Primary Care Physician Services: $0 copay · Out: 7a: 25% coinsurance
Quick view
Specialist
In: Physician Specialist Services: $45 copay · Out: 7d: 25% coinsurance
Quick view
Preventive care
In: Annual Physical Exam: $0 copay; Kidney Disease Education Services: $0 copay; Glaucoma Screening: $0 copay; Diabetes Self-Management Training: $0 copay; Digital Rectal Exams: $0 copay; EKG following Welcome Visit: $0 copay · Out: 14b: $0 copay; 14d: $0 copay; 14e1: $0 copay; 14e2: $0 copay; 14e4: $0 copay; 14e5: $0 copay; 14a: $0 copay
Quick view
Diagnostic procedures & tests
In: Diagnostic Procedures/Tests: $0–$180 copay · Out: 8a1: $40 copay + 25%–50% coinsurance
Quick view
Laboratory services
In: Lab Services: $0 copay · Out: 8a2: $40 copay + 25%–50% coinsurance
Quick view
X-rays & standard imaging
In: Outpatient X-Ray Services: $0–$145 copay · Out: 8b3: $40 copay + 25%–50% coinsurance
Quick view
MRI, CT & PET imaging
In: Diagnostic Radiological Services: $0–$345 copay · Out: 8b1: $0 copay + 50% coinsurance
Quick view
Urgent care
In: Urgently Needed Services: $40 copay · Out: Not separately reported
Quick view
Emergency room
In: $115 copay · Out: Not separately reported
Quick view
Ground ambulance
In: $325 copay · Out: $325 copay
Quick view
Air ambulance
In: 20% coinsurance · Out: 20% coinsurance
Quick view
Outpatient hospital
In: Outpatient Hospital Services: $0–$475 copay; Observation Services: $375 copay · Out: 9a1: $0 copay + 25%–50% coinsurance; 9a2: 50% coinsurance
Quick view
Outpatient surgery / ASC
In: Ambulatory Surgical Center (ASC) Services: $0–$400 copay · Out: 9b: $0 copay + 50% coinsurance
Quick view
Home health
In: $0 copay · Out: 50% coinsurance
Quick view
Skilled nursing facility
In: Skilled nursing facility: Tier 1: $0 / day for days 1–20; $221 / day for days 21–100 · Out: Skilled nursing facility: Tier 1: 50% coinsurance
Quick view
Cardiac & pulmonary rehabilitation
In: Cardiac Rehabilitation Services: $30 copay; Intensive Cardiac Rehabilitation Services: $30 copay; Pulmonary Rehabilitation Services: $25 copay; SET for PAD Services: $20 copay; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable · Out: 3-1: 50% coinsurance; 3-2: 50% coinsurance; 3-3: 50% coinsurance; 3-4: 50% coinsurance
Quick view
Occupational therapy
In: Occupational Therapy Services: $25 copay · Out: 7c: 25%–50% coinsurance
Quick view
Physical & speech therapy
In: Physical Therapy and Speech-Language Pathology Services: $25 copay · Out: 7i: 25%–50% coinsurance
Quick view
Mental health services
In: Partial Hospitalization Program: $35 copay; Individual Sessions for Mental Health Specialty Services: $35 copay; Group Sessions for Mental Health Specialty Services: $35 copay; Individual Sessions for Psychiatric Services: $35 copay; Group Sessions for Psychiatric Services: $35 copay; Inpatient psychiatric hospital: Tier 1: $375 / day for days 1–5; $0 / day for days 6–90 · Out: 5a: 50% coinsurance; 7e1: 25% coinsurance; 7e2: 25% coinsurance; 7h1: 25% coinsurance; 7h2: 25% coinsurance; Inpatient psychiatric hospital: Tier 1: 50% coinsurance
Quick view
Substance use treatment
In: Intensive Outpatient Program Services: $35 copay; Individual Sessions for Outpatient Substance Abuse: $35 copay; Group Sessions for Outpatient Substance Abuse: $35 copay · Out: 5b: 50% coinsurance; 9c1: 25%–50% coinsurance; 9c2: 25%–50% coinsurance
Quick view
Podiatry
In: Podiatry Services: $45 copay; 7f(NMC): Not applicable · Out: 7f: 25% coinsurance
Quick view
Chiropractic
In: Chiropractic Services: $15 copay · Out: 7b: 30% coinsurance
Quick view
Dental
In: Medicare Dental Services: $45 copay; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Prophylaxis (Cleaning): $0 copay; Periodontics: $0 copay; Adjunctive General Services: $0 copay · Out: 16a: 25% coinsurance; 16b1: $0 copay; 16b2: $0 copay; 16b4: $0 copay; 16c3: $0 copay; 16c10: $0 copay
Quick view
Vision
In: Eye Exams: $0–$45 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 copay; Contact Lenses: $0 copay; Eyeglasses (lenses and frames): $0 copay; Eyeglass lenses: Not applicable; Eyeglass frames: Not applicable; Upgrades: Not applicable · Out: 17a: $0 copay + 25% coinsurance; 17a1: $0 copay; 17b: $0 copay; 17b1: $0 copay; 17b2: $0 copay
Quick view
Hearing
In: Hearing Exams: $45 copay; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: $0 copay; Prescription Hearing Aids (all types): $575–$750 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable · Out: 18a: 25% coinsurance; 18a1: 95% coinsurance; 18a2: 95% coinsurance; 18b1: 95% coinsurance
Quick view
Transportation
In: 10b(NMC): Not applicable · Out: Not separately reported
Quick view
Fitness & wellness
In: Fitness Benefit: $0 copay · Out: 14c4: 95% coinsurance
Quick view
Over-the-counter allowance
In: Over-the-Counter (OTC) Items: Not applicable · Out: Not separately reported
Quick view
Meals
In: Meal Benefit: $0 copay · Out: 13c: 95% coinsurance
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-networkPrimary Care Physician Services: $0 copay
Out-of-network7a: 25% coinsurance
Specialist
In-networkPhysician Specialist Services: $45 copay
Out-of-network7d: 25% coinsurance
Preventive care
In-networkAnnual Physical Exam: $0 copay; Kidney Disease Education Services: $0 copay; Glaucoma Screening: $0 copay; Diabetes Self-Management Training: $0 copay; Digital Rectal Exams: $0 copay; EKG following Welcome Visit: $0 copay
Out-of-network14b: $0 copay; 14d: $0 copay; 14e1: $0 copay; 14e2: $0 copay; 14e4: $0 copay; 14e5: $0 copay; 14a: $0 copay
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-networkDiagnostic Procedures/Tests: $0–$180 copay
Out-of-network8a1: $40 copay + 25%–50% coinsurance
Laboratory services
In-networkLab Services: $0 copay
Out-of-network8a2: $40 copay + 25%–50% coinsurance
X-rays & standard imaging
In-networkOutpatient X-Ray Services: $0–$145 copay
Out-of-network8b3: $40 copay + 25%–50% coinsurance
MRI, CT & PET imaging
In-networkDiagnostic Radiological Services: $0–$345 copay
Out-of-network8b1: $0 copay + 50% coinsurance
Urgent & hospital care6 benefits
Urgent care
In-networkUrgently Needed Services: $40 copay
Out-of-networkNot separately reported
Emergency room
In-network$115 copay
Out-of-networkNot separately reported
Ground ambulance
In-network$325 copay
Out-of-network$325 copay
Air ambulance
In-network20% coinsurance
Out-of-network20% coinsurance
Outpatient hospital
In-networkOutpatient Hospital Services: $0–$475 copay; Observation Services: $375 copay
Out-of-network9a1: $0 copay + 25%–50% coinsurance; 9a2: 50% coinsurance
Outpatient surgery / ASC
In-networkAmbulatory Surgical Center (ASC) Services: $0–$400 copay
Out-of-network9b: $0 copay + 50% coinsurance
Recovery & therapy5 benefits
Home health
In-network$0 copay
Out-of-network50% coinsurance
Skilled nursing facility
In-networkSkilled nursing facility: Tier 1: $0 / day for days 1–20; $221 / day for days 21–100
Out-of-networkSkilled nursing facility: Tier 1: 50% coinsurance
Cardiac & pulmonary rehabilitation
In-networkCardiac Rehabilitation Services: $30 copay; Intensive Cardiac Rehabilitation Services: $30 copay; Pulmonary Rehabilitation Services: $25 copay; SET for PAD Services: $20 copay; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-network3-1: 50% coinsurance; 3-2: 50% coinsurance; 3-3: 50% coinsurance; 3-4: 50% coinsurance
Occupational therapy
In-networkOccupational Therapy Services: $25 copay
Out-of-network7c: 25%–50% coinsurance
Physical & speech therapy
In-networkPhysical Therapy and Speech-Language Pathology Services: $25 copay
Out-of-network7i: 25%–50% coinsurance
Behavioral health2 benefits
Mental health services
In-networkPartial Hospitalization Program: $35 copay; Individual Sessions for Mental Health Specialty Services: $35 copay; Group Sessions for Mental Health Specialty Services: $35 copay; Individual Sessions for Psychiatric Services: $35 copay; Group Sessions for Psychiatric Services: $35 copay; Inpatient psychiatric hospital: Tier 1: $375 / day for days 1–5; $0 / day for days 6–90
Out-of-network5a: 50% coinsurance; 7e1: 25% coinsurance; 7e2: 25% coinsurance; 7h1: 25% coinsurance; 7h2: 25% coinsurance; Inpatient psychiatric hospital: Tier 1: 50% coinsurance
Substance use treatment
In-networkIntensive Outpatient Program Services: $35 copay; Individual Sessions for Outpatient Substance Abuse: $35 copay; Group Sessions for Outpatient Substance Abuse: $35 copay
Out-of-network5b: 50% coinsurance; 9c1: 25%–50% coinsurance; 9c2: 25%–50% coinsurance
Specialty care2 benefits
Podiatry
In-networkPodiatry Services: $45 copay; 7f(NMC): Not applicable
Out-of-network7f: 25% coinsurance
Chiropractic
In-networkChiropractic Services: $15 copay
Out-of-network7b: 30% coinsurance
Supplemental benefits7 benefits
Dental
In-networkMedicare Dental Services: $45 copay; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Prophylaxis (Cleaning): $0 copay; Periodontics: $0 copay; Adjunctive General Services: $0 copay
Out-of-network16a: 25% coinsurance; 16b1: $0 copay; 16b2: $0 copay; 16b4: $0 copay; 16c3: $0 copay; 16c10: $0 copay
Vision
In-networkEye Exams: $0–$45 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 copay; Contact Lenses: $0 copay; Eyeglasses (lenses and frames): $0 copay; Eyeglass lenses: Not applicable; Eyeglass frames: Not applicable; Upgrades: Not applicable
Out-of-network17a: $0 copay + 25% coinsurance; 17a1: $0 copay; 17b: $0 copay; 17b1: $0 copay; 17b2: $0 copay
Hearing
In-networkHearing Exams: $45 copay; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: $0 copay; Prescription Hearing Aids (all types): $575–$750 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Out-of-network18a: 25% coinsurance; 18a1: 95% coinsurance; 18a2: 95% coinsurance; 18b1: 95% coinsurance
Transportation
Not applicableIn-network10b(NMC): Not applicable
Out-of-networkNot separately reported
Fitness & wellness
In-networkFitness Benefit: $0 copay
Out-of-network14c4: 95% coinsurance
Over-the-counter allowance
Not applicableIn-networkOver-the-Counter (OTC) Items: Not applicable
Out-of-networkNot separately reported
Meals
In-networkMeal Benefit: $0 copay
Out-of-network13c: 95% coinsurance
Plan costs & rulesCoverage overview
Premium & Part B giveback
$0 Part C premium / month · CMS reports a Part B premium reduction of $110 per month.
Maximum out-of-pocket (MOOP)
In-network$9,850
Combined in + out$14,800
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Annual health deductible
$600
Combined network deductible
Not separately reported
Part D premium
$0 / month
Network & referrals
Local PPO · Referrals: Not required · Out-of-network coverage: Yes
Prescription drugs5 tiers
Part D deductible
$700 / year
Drug tier 1
Standard retail: $0 copay · Preferred retail: $0 copay · 30-day supply
Drug tier 2
Standard retail: $4 copay · Preferred retail: $4 copay · 30-day supply
Drug tier 3
Standard retail: 19% coinsurance · Preferred retail: 19% coinsurance · 30-day supply
Drug tier 4
Standard retail: 30% coinsurance · Preferred retail: 30% coinsurance · 30-day supply
Drug tier 5
Standard retail: 25% coinsurance · Preferred retail: 25% coinsurance · 30-day supply
Using this plan
Understand H5525-035-000
Plain-language context built from this plan’s 2027 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.
Plan at a glance
A quick read on this plan
HumanaChoice Giveback H5525-035 (PPO) is a 2027 Local PPO offered by Humana in North Carolina. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals. Its listed inpatient copay stages total $2,625 across 7 charged days.
Common benefit costs
What you may pay
These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.
Routine care
- Primary care physician
- Primary Care Physician Services: $0 copay
- Specialist
- Physician Specialist Services: $45 copay
- Laboratory services
- Lab Services: $0 copay
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- Diagnostic Procedures/Tests: $0–$180 copay
- MRI, CT & PET imaging
- Diagnostic Radiological Services: $0–$345 copay
- Outpatient hospital
- Outpatient Hospital Services: $0–$475 copay; Observation Services: $375 copay
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $115 copay
- Listed inpatient stages
- $2,625 total
7 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.
Helpful context
Terms worth knowing
Maximum out-of-pocket (MOOP)
This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.
Part B premium reduction (“giveback”)
A giveback may reduce the amount you pay toward Medicare Part B; it is not usually paid to you as cash. The CMS record notes: CMS reports a Part B premium reduction of $110 per month.
Availability
Who can enroll
- Service area
- North Carolina (NC)
- Plan type
- Local PPO
- Contract / plan
- H5525-035
- Coverage year
- 2027
Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.
Supplemental coverage
Extra benefits reported
Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.
DentalMedicare Dental Services: $45 copay; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 copay; Dental X-Rays: $0 copay; Prophylaxis (Cleaning): $0 copay; Periodontics: $0 copay; Adjunctive General Services: $0 copay
VisionEye Exams: $0–$45 copay; Routine Eye Exams: $0 copay; Other Eye Exam Services: Not applicable; Eyewear: $0 copay; Contact Lenses: $0 copay; Eyeglasses (lenses and frames): $0 copay; Eyeglass lenses: Not applicable; Eyeglass frames: Not applicable; Upgrades: Not applicable
HearingHearing Exams: $45 copay; Routine Hearing Exams: $0 copay; Fitting/Evaluation for Hearing Aid: $0 copay; Prescription Hearing Aids (all types): $575–$750 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Fitness & wellnessFitness Benefit: $0 copay
MealsMeal Benefit: $0 copay
Plan-specific answers
Frequently asked questions
Where is H5525-035-000 available?
HumanaChoice Giveback H5525-035 (PPO) is listed for North Carolina (NC). Enrollment generally requires Medicare eligibility and residence in the plan's service area.
What is the in-network maximum out-of-pocket limit for H5525-035-000?
The 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $9,850. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H5525-035-000?
The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H5525-035-000?
The plan record lists $115 copay, waived when an admission meets the plan's stated timing rule.
Does H5525-035-000 report extra benefits?
Yes. CMS reports dental, vision, hearing, fitness & wellness, meals. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2027
Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.
Plan context
Where H5525-035-000 fits
- Full CMS plan ID
H5525-035-000- Contract
H5525- Base plan code
H5525-035- Segment
000- Carrier
- Humana
- Plan type
- Local PPO
- Service area
- North Carolina (NC)
County/service-area foundation
CMS service-area entries
Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.
- Alamance, NC
- Alexander, NC
- Anson, NC
- Ashe, NC
- Avery, NC
- Beaufort, NC
- Bladen, NC
- Brunswick, NC
- Buncombe, NC
- Burke, NC
- Caldwell, NC
- Caswell, NC
74 additional service-area entries are retained in the data record.
Exact county navigation
Counties with exact segment geography
These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.
Show 86 county links
North Carolina
- Alamance County, North Carolina
- Alexander County, North Carolina
- Anson County, North Carolina
- Ashe County, North Carolina
- Avery County, North Carolina
- Beaufort County, North Carolina
- Bladen County, North Carolina
- Brunswick County, North Carolina
- Buncombe County, North Carolina
- Burke County, North Carolina
- Caldwell County, North Carolina
- Caswell County, North Carolina
- Catawba County, North Carolina
- Chatham County, North Carolina
- Chowan County, North Carolina
- Cleveland County, North Carolina
- Columbus County, North Carolina
- Cumberland County, North Carolina
- Currituck County, North Carolina
- Davidson County, North Carolina
- Davie County, North Carolina
- Duplin County, North Carolina
- Durham County, North Carolina
- Edgecombe County, North Carolina
- Forsyth County, North Carolina
- Franklin County, North Carolina
- Gaston County, North Carolina
- Graham County, North Carolina
- Granville County, North Carolina
- Greene County, North Carolina
- Guilford County, North Carolina
- Halifax County, North Carolina
- Harnett County, North Carolina
- Haywood County, North Carolina
- Henderson County, North Carolina
- Hertford County, North Carolina
- Hoke County, North Carolina
- Hyde County, North Carolina
- Iredell County, North Carolina
- Jackson County, North Carolina
- Johnston County, North Carolina
- Jones County, North Carolina
- Lee County, North Carolina
- Lenoir County, North Carolina
- Lincoln County, North Carolina
- Macon County, North Carolina
- Madison County, North Carolina
- Martin County, North Carolina
- McDowell County, North Carolina
- Mecklenburg County, North Carolina
- Mitchell County, North Carolina
- Montgomery County, North Carolina
- Moore County, North Carolina
- Nash County, North Carolina
- New Hanover County, North Carolina
- Northampton County, North Carolina
- Orange County, North Carolina
- Pamlico County, North Carolina
- Pasquotank County, North Carolina
- Perquimans County, North Carolina
- Person County, North Carolina
- Polk County, North Carolina
- Randolph County, North Carolina
- Richmond County, North Carolina
- Robeson County, North Carolina
- Rockingham County, North Carolina
- Rowan County, North Carolina
- Rutherford County, North Carolina
- Sampson County, North Carolina
- Scotland County, North Carolina
- Stanly County, North Carolina
- Stokes County, North Carolina
- Surry County, North Carolina
- Transylvania County, North Carolina
- Tyrrell County, North Carolina
- Union County, North Carolina
- Vance County, North Carolina
- Wake County, North Carolina
- Warren County, North Carolina
- Washington County, North Carolina
- Watauga County, North Carolina
- Wayne County, North Carolina
- Wilkes County, North Carolina
- Wilson County, North Carolina
- Yadkin County, North Carolina
- Yancey County, North Carolina
About this code
What H5525-035-000 identifies
H5525-035-000 is a Contract Year 2027 Medicare plan segment code. Searches written as H5525-035, H5525 035, or the compact full CMS ID H5525035000 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.