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HumanaChoice H5525-056 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-056 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-056 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-056 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 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.
For HumanaChoice H5525-056 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $64.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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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.
Inpatient Hospital See details
HumanaChoice H5525-056 (PPO) partially covers inpatient hospital services with no coinsurance. Acute care requires a $500 copay for days 1-5 and no copay for days 6-999, excluding upgrades and non-Medicare stays, while psychiatric care requires a $421 copay for days 1-5 and no copay for days 6-90, excluding additional days and non-Medicare stays.
Outpatient Services See details
HumanaChoice H5525-056 (PPO) covers outpatient services with no coinsurance, featuring no copay and no deductible for ambulatory surgical center and blood services. Copayments for other covered services range from $25 to $35 for outpatient substance abuse sessions, $0 to $325 for outpatient hospital services, and $500 per stay for observation services.
Partial Hospitalization See details
HumanaChoice H5525-056 (PPO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5525-056 (PPO) covers ambulance services with a $335 copay for ground transport and a $1,250 copay for air transport, both requiring prior authorization and having no coinsurance. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5525-056 (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-056 (PPO) offers partially covered Primary Care benefits, with routine chiropractic care and podiatry services not covered. Covered services require no coinsurance, with copays ranging from no copay for primary care physician visits up to $50 for telehealth.
Preventive Services See details
HumanaChoice H5525-056 (PPO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. For additional preventive services, some services are covered in theory, but in practice, none of the sub-services—including fitness benefits, health education, weight management, and in-home safety assessments—are covered.
Hearing Services See details
Hearing services are partially covered by HumanaChoice H5525-056 (PPO), as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered. Routine exams and fitting evaluations feature no copay and no coinsurance, while Medicare-covered exams have a $30 copay and covered prescription hearing aids require a $599 to $899 copay, both with no coinsurance.
Vision Services See details
HumanaChoice H5525-056 (PPO) provides partially covered vision services, including eye exams with a $0 to $30 copay and no coinsurance, up to a $75 annual limit. Eyewear is covered with no copay and no coinsurance up to a $150 annual limit for contact lenses and complete eyeglasses, while individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5525-056 (PPO), with fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics excluded from coverage. Covered preventive care features no copay and no coinsurance up to a $750 annual limit, Medicare dental services require a $30 copay with no coinsurance, and comprehensive services like restorative care require a 30% to 40% coinsurance with no copay.
Home Infusion bundled Services See details
HumanaChoice H5525-056 (PPO) covers home infusion bundled services, which require prior authorization. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs carry a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-056 (PPO) plan with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5525-056 (PPO) covers durable medical equipment (DME) with a 15% coinsurance and no copay, and prosthetic devices or medical supplies with a 15% to 20% coinsurance and no copay. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay. Prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
HumanaChoice H5525-056 (PPO) covers diagnostic and radiological services with prior authorization, requiring no coinsurance for most services except for a 20% coinsurance with no copay on therapeutic radiology. Members will pay a $5 copay for lab services, between no copay and a $100 copay for diagnostic procedures, no copay for outpatient X-rays, and up to a $300 copay for diagnostic radiology with no coinsurance.
Home Health Services See details
HumanaChoice H5525-056 (PPO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
HumanaChoice H5525-056 (PPO) states that some services are covered under the Cardiac Rehabilitation Services benefit, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Since these services are not covered, there are no copays or coinsurance costs, though prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by HumanaChoice H5525-056 (PPO), requiring a daily copay of $10 for days 1 to 20 and $218 for days 21 to 100, with no coinsurance. Prior authorization is required, and additional days beyond Medicare-covered stays are not covered.
Other Services See details
HumanaChoice H5525-056 (PPO) partially covers other services, offering up to 20 acupuncture treatments per year for a $30 copay and no coinsurance with prior authorization. Over-the-counter items, meal benefits, and dual eligible SNP services are not covered.
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