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HumanaChoice H5525-074 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-074 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-074 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-074 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in California. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-074 (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 H5525-074 (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 H5525-074 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.00. 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 $5500.00 (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 $5500.00 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 H5525-074 (PPO) Medicare plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, Tier 1 preferred generic drugs require a $2.00 copay at standard pharmacies and preferred mail-order, while Tier 2 standard generics require a $47.00 copay. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs carry a coinsurance of 47% and 25% respectively. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, individuals who qualify for the low-income subsidy, also known as Extra Help, will pay no premium for their Part D coverage.
Additional Benefits
The HumanaChoice H5525-074 (PPO) plan offers robust medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits and routine preventive services. For specialized care, members can expect copays between $10 and $35 for specialists and a $300 daily copay for the first seven days of inpatient hospital stays. Outpatient hospital services require no coinsurance, with copays ranging from $0 to $350, alongside no copay for ambulatory surgical centers. Supplemental benefits further enhance this plan, providing dental coverage with no copay up to a $2,000 annual maximum for most services. Routine vision and hearing exams also feature no copay, with additional allowances of up to $250 for eyewear and coverage for two prescription hearing aids with copays from $599 to $899. Other essential services, like home health care, require no copay or coinsurance, while emergency room visits carry a $150 copay.
Inpatient Hospital See details
HumanaChoice H5525-074 (PPO) partially covers inpatient hospital care with a $300 daily copay for days 1 to 7, no copay for days 8 to 90, and no coinsurance. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5525-074 (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Patients will pay a copay of $0 to $350 for outpatient hospital services, $300 per stay for observation services, and $25 to $35 per session for outpatient substance abuse services.
Partial Hospitalization See details
HumanaChoice H5525-074 (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 H5525-074 (PPO) covers ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. For transportation services, some services are covered, but transportation to plan-approved and any health-related locations is not covered.
Emergency Services See details
HumanaChoice H5525-074 (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits are partially covered by HumanaChoice H5525-074 (PPO), featuring primary care provider visits with no copay and no coinsurance, and specialist, therapy, or mental health services with copays from $10 to $35 and no coinsurance. While telehealth services are also covered with copays up to $30, podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive Services are partially covered by HumanaChoice H5525-074 (PPO) with no copays and no coinsurance for covered services like annual physicals, kidney disease education, glaucoma screenings, diabetes self-management, and memory fitness. Excluded from coverage are health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
HumanaChoice H5525-074 (PPO) partially covers hearing services with no deductible and no coinsurance, offering routine exams and fitting evaluations with no copay, and Medicare-covered exams for a $10 copay. Up to two prescription hearing aids (all types) are covered annually with a $599 to $899 copay, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
HumanaChoice H5525-074 (PPO) partially covers vision services with no coinsurance, though prior authorization is required. Eye exams are covered with a $0 to $10 copay (no copay for routine exams), and eyewear is covered with no copay up to a $250 annual limit. However, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-074 (PPO) partially covers dental services, with no coverage for fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Covered Medicare dental services require a $10 copay and no coinsurance, while all other covered dental benefits have no copay and no coinsurance up to a $2,000 annual maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HumanaChoice H5525-074 (PPO) and require prior authorization. Chemotherapy, radiation, and other Part B drugs have a 0% to 20% coinsurance and no copay, 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 H5525-074 (PPO) plan with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5525-074 (PPO) covers medical equipment, including durable medical equipment (DME) and medical supplies with a 15% coinsurance and no copay. Prosthetic devices and diabetic supplies are covered with a 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HumanaChoice H5525-074 (PPO) with prior authorization, featuring no copay or coinsurance for lab services and outpatient X-rays. Diagnostic procedures and tests carry a copay of $0 to $85 with no coinsurance, while diagnostic radiological services have a copay of up to $300 with no coinsurance. Therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
HumanaChoice H5525-074 (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 H5525-074 (PPO) indicates some services are covered under the Cardiac Rehabilitation Services benefit, though in practice, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-074 (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring a daily copay of $20 for days 1 through 20 and $218 for days 21 through 100, with no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by HumanaChoice H5525-074 (PPO), featuring acupuncture coverage for a $10 copay and no coinsurance for up to 20 treatments per year. Over-the-counter (OTC) items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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