Humana Dual Select H5525-046 (PPO D-SNP)
H5525-046 • 2026 • Sandusky County, OH
Humana Dual Select H5525-046 (PPO D-SNP) H5525-046 • 2026 • Sandusky County, OH
Humana Dual Select H5525-046 is a Medicare Dual-Eligible plan offered by Humana for the 2026 plan year. It is identified by CMS Plan ID H5525-046 and serves individuals who meet defined eligibility criteria.
Humana Dual Select H5525-046 Overview
Plan Overview for H5525-046-0 | |
|---|---|
| CMS Plan ID: | H5525-046-0 |
| Plan Type: | PPO D-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $31.40 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $9250.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Sandusky County, OH |
| Enrollment (Nationwide) | 5,991 beneficiaries |
| Enrollment (CMS – Local) | 16 beneficiaries in Sandusky County |
| Provided By: | Humana |
Plan Overview and Eligibility
Humana Dual Select H5525-046 is a Medicare D-SNP plan for dual-eligible beneficiaries (Medicare and Medicaid).
- You must have Medicare Part A and Part B, live in one of the plan's specific service areas, and qualify for Medicaid to enroll.
- It includes Medicare Part D prescription drug coverage. The annual Part D deductible is $615.00.
- Benefits and cost-sharing may be coordinated with Medicaid coverage.
- Extra Help may provide additional assistance with prescription drug costs.
This plan uses a Preferred Provider Organization (PPO) network, allowing you to see providers both inside and outside the network. Costs are typically lower when using in-network providers, and referrals are not usually needed for specialist care. Emergency care and out-of-area dialysis are covered.
Covered Services and Cost Structure
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
| Specialist: | In-network: 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 or $0-$35 copay, 0% or 20% coinsurance |
| Routine chiropractic: | Not covered |
| Fitness benefits: | Not covered |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $0 or $0-$335 copay, 0% or 20% coinsurance | Out-of-network: $0 or $0-$335 copay, 0% or 20% coinsurance |
| Lab services: | In-network: $0 copay, 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
| Outpatient x-rays: | In-network: $0 or $50 copay, 0% or 20% coinsurance | Out-of-network: $0 or $50 copay, 0% or 20% coinsurance |
| Diagnostic tests and procedures: | In-network: $0 copay, 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $0 or $115 copay |
| Worldwide emergency care: | $115 copay |
| Urgent care: | 0% or 20% coinsurance |
| Inpatient hospital care: | In-network: | Tier 1 | $0 or $2,230 per stay | Out-of-network: | $0 or $2,230 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $0 or $218 per day for days 21-100 | Out-of-network: | $0 per day for days 1-20 | $0 or $218 per day for days 21-100 | $0 per stay |
| Ground ambulance: | In-network: $0 or $335 copay | Out-of-network: $0 or $335 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $0 or $35 copay | Out-of-network: $0 or $35 copay |
| Outpatient group therapy: | In-network: $0 or $35 copay | Out-of-network: $0 or $35 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $0 or $2,230 per stay | Out-of-network: | $0 or $2,230 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
| Occupational therapy: | In-network: 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay, 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
| Durable medical equipment: | In-network: $0 copay, 0% or 20% coinsurance | Out-of-network: $0 copay, 0% or 20% coinsurance |
| Prosthetics: | In-network: 0% or 20% coinsurance | Out-of-network: 0% or 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0% or 0%-20% coinsurance | Out-of-network: 0% or 20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: $0 copay, 0% or 0%-20% coinsurance | Out-of-network: $0 copay, 0% or 20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $0 copay |
| Cleaning: | In-network: $0 copay | Out-of-network: $0 copay |
| Periodontics: | In-network: $0 copay | Out-of-network: $0 copay |
| Endodontics: | In-network: $0 copay | Out-of-network: $0 copay |
| Restorative services: | In-network: $0 copay | Out-of-network: $0 copay |
| Implant services: | In-network: $0 copay | Out-of-network: $0 copay |
| Orthodontics: | In-network: $0 copay | Out-of-network: $0 copay |
| Oral/Maxillofacial surgery: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay |
| Upgrades: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Prescription hearing aids: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| OTC hearing aids: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | In-network: $0 copay | Out-of-network: $0 copay |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $31.40 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $31.40 |
| Low Income Premium Subsidy: | $31.38 |
| Low Income Premium Subsidy CMS Pays: | $31.40 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Drug Plan Deductible
The prescription drug annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before Humana begins paying its share.
Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and drug plan deductible, Humana Dual Select H5525-046 has costs that you must pay out-of-pocket when you pick up your prescriptions. The following table details those costs by formulary tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 25% coinsurance | Coming soon |
| Specialty Tier | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Plan Star Ratings
Medicare assigns star ratings to plans based on quality and performance across multiple measures, including customer service, member experience, and health outcomes. Ratings are updated annually by the Centers for Medicare & Medicaid Services (CMS) and are shown on a 1 to 5 star scale, with 5 stars representing the highest quality.
CMS Star Ratings for Plan H5525-046-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Humana
| Contact Type | Details |
|---|---|
| Website: | Humana Plan Page |
| New Members: | 1-888-873-0686 |
| Existing Members: | 1-800-457-4708 |
| Plan Address: | 101 E Main Street | Louisville, KY 40202 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation.
- Humana (official source), http://www.humana.com/medicare — Last accessed April 30, 2026
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)" — Last accessed April 28, 2026
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed April 28, 2026
- Medicare.gov, "Joining a plan" — Last accessed April 28, 2026
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