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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 2025, 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 2025.
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 $11.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $2.00 copay for preferred generic drugs at a standard or preferred mail pharmacy. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-074 (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while many outpatient services have no copay. Emergency, primary care, preventive, hearing, vision, and dental services are covered with a mix of copays and no copays. This plan also includes coverage for ambulance, home infusion, and medical equipment with copays or coinsurance. Additionally, services like skilled nursing facilities and diagnostic services are available with specific cost-sharing structures. However, some services, such as cardiac rehabilitation, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-5, there is a $250 copay, and for days 6-90, there is no copay; additional days for inpatient acute care have no copay.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a copay between $0 and $250, Observation Services with a $250 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions, and Outpatient Blood Services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-074 (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HumanaChoice H5525-074 (PPO). Ground and Air Ambulance Services have a $300 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $100 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $100 copay.
Primary Care See details
The HumanaChoice H5525-074 (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $10 copay. Occupational therapy services have a $10 copay and physical therapy and speech-language pathology services have a $10 copay. Physician specialist services have a $10 copay, and mental health and psychiatric individual and group sessions each have a $20 copay. Additional telehealth benefits have a copay between $0 and $30, and Opioid Treatment Program Services have a $20 copay.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services. Additional preventive services include Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services which are not covered. Other services include Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a $10 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription Hearing Aids (all types) have a copay between $499 and $799, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are also not covered.
Vision Services See details
The HumanaChoice H5525-074 (PPO) plan covers vision services including eye exams and eyewear. Eye exams have a copay between $0 and $10, and eyewear has no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The HumanaChoice H5525-074 (PPO) plan covers dental services, including Medicare dental services with a $10 copay, and other dental services. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery are covered with no copay. Prosthodontics (removable and fixed) have a 30% coinsurance and no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the HumanaChoice H5525-074 (PPO) plan, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the HumanaChoice H5525-074 (PPO) plan and require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME and Diabetic Supplies have a 20% coinsurance, and Prosthetic Devices have a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the HumanaChoice H5525-074 (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $85, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $250, Therapeutic Radiological Services have a copay of $75, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-074 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice H5525-074 (PPO) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-074 (PPO) plan, but require prior authorization. For days 1-20, there is a $20 copay, for days 21-32 there is a $203 copay, and for days 33-100 there is no copay. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture with a $10 copay, and a limit of 20 treatments per year, but other services like over-the-counter items, meal benefits, and several other services are not covered.
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