HumanaChoice H5525-056 (PPO)

HumanaChoice H5525-056 (PPO) is a PPO plan offered by Humana Benefit Plan of Illinois, Inc. available for the 2026 plan year to people living in Northern California Area. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that HumanaChoice H5525-056 (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.

Key Plan Facts

Below are a few key facts and commonly-asked questions about HumanaChoice H5525-056 (PPO).

Plan Costs:

The cost of a Medicare Advantage Plan is made up of four main parts.

• First, the monthly premium — the amount you pay every month.
• Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
• Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
• Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.

You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.

Common Services:

Drug Coverage

The HumanaChoice H5525-056 (PPO) Medicare plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, Tier 1 preferred generic drugs have a $5.00 copay at standard pharmacies and preferred mail-order services. Tier 2 standard generics carry a $47.00 copay, while Tier 3 preferred brands require 48% coinsurance and Tier 4 non-preferred drugs require 25% coinsurance. After your annual out-of-pocket drug expenses reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy or Extra Help, your prescription cost is reduced to $2.30. This plan provides clear, tiered cost-sharing to help you plan your annual healthcare budget.

Additional Benefits

The HumanaChoice H5525-056 (PPO) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copay for primary care physician visits, annual physical exams, and home health services. For more intensive care, members will pay set copayments, such as a $500 daily copay for the first five days of acute inpatient hospital stays and a $130 copay for emergency room visits. Outpatient surgical services and diagnostic X-rays are also highly accessible, requiring no copay and no coinsurance. This plan also includes essential supplemental benefits, including preventive dental care with no copay up to a $750 annual limit and routine vision exams with no copay to a $30 copay. Prescription hearing aids require copayments ranging from $599 to $899, while specialized needs like durable medical equipment and dialysis services are covered with a 15% to 20% coinsurance. Skilled nursing facility stays are also covered, requiring a low daily copay of $10 for the first 20 days.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.