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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 2025, 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 2025.
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 $63.00. 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 $250.00 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 $8950.00 (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 $8950.00 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) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you may pay a $10 copay for preferred generic drugs at a standard or mail-order pharmacy, or 45% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice H5525-056 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays between $0 and $250. Emergency services, primary care, and preventive services, including an annual physical, are covered with copays ranging from $0 to $125. The plan also includes coverage for hearing, vision, and dental services. Hearing exams and vision services have copays, while dental services have a $1,000 annual maximum with no copay for preventative services. Additional benefits include ambulance, home health, and home infusion services, as well as coverage for skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital coverage with the HumanaChoice H5525-056 (PPO) plan includes a $500 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric has a $421 copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $0 and $250, and observation services with a $500 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay between $40 and $100 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-056 (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the HumanaChoice H5525-056 (PPO) plan. Ground Ambulance Services have a $315 copay, and Air Ambulance Services have a $1250 copay, but Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the HumanaChoice H5525-056 (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, with no coinsurance for either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay.
Primary Care See details
The HumanaChoice H5525-056 (PPO) plan covers primary care physician services with a $5 copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $25 copay, mental health specialty services with a $40 copay, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits with a copay ranging from $0 to $55, and opioid treatment program services with a copay ranging from $40 to $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The HumanaChoice H5525-056 (PPO) plan covers preventive services, including an annual physical exam with no copay. Additionally, other preventive services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Other services such as Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The HumanaChoice H5525-056 (PPO) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $499 and $799, while inner ear, outer ear, and over-the-ear prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5525-056 (PPO) plan covers vision services, including eye exams with a copay of $0-$25 and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5525-056 (PPO) plan offers dental services with a $1,000 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay, while prosthodontics and fixed services have a 30% coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5525-056 (PPO) plan. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered by HumanaChoice H5525-056 (PPO), with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies, and no copay. Diabetic Therapeutic Shoes/Inserts have no copay, and Diabetic Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures/tests with a copay that ranges from $0 to $100, lab services with a $5 copay, diagnostic radiological services with a copay up to $250, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $5 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-056 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the specific sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5525-056 (PPO) plan, but require prior authorization. You will pay a copay of $10 for days 1-20, and a copay of $188 for days 21-100.
Other Services See details
Other Services includes coverage for acupuncture with a $25 copay, but the plan does not cover over-the-counter items, meal benefits, dual eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. Acupuncture treatments are limited to 20 per year and require prior authorization.
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