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HumanaChoice H5525-075 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-075 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-075 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-075 (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 H5525-075 (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 H5525-075 (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 H5525-075 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $15.00. You must continue to pay paying your reduced 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 $6200.00 (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 $6200.00 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 H5525-075 (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $5.00 copay at a preferred pharmacy, while preferred brand drugs have a 50% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HumanaChoice H5525-075 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $350 copay for days 1-5, and no copay for days 6-90. Outpatient services have copays ranging from $0 to $350, and emergency services have a $120 copay. This plan includes no copays for primary care visits and preventive services, with some services like hearing exams, vision exams, and dental services also having no copay. Other services, like ambulance, have a $300 copay. The plan also covers hearing aids and offers a $1,000 maximum benefit for dental services.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered. For days 1-5, there is a $350 copay, and for days 6-90, there is no copay; additional days for inpatient hospital-acute have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $350, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a $20 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-075 (PPO) plan, with a $55 copay and prior authorization required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5525-075 (PPO) plan. Ground and Air Ambulance Services have a $300 copay, with no coinsurance, while 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 by the HumanaChoice H5525-075 (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, and Urgently Needed Services have a $30 copay; all have no coinsurance.
Primary Care See details
Primary Care Physician Services are covered with no copay, while Chiropractic Services have a $20 copay. Occupational Therapy Services have a $20 copay, and Physician Specialist Services have a $25 copay. Mental Health and Psychiatric Services have a $20 copay for both individual and group sessions, and Physical Therapy and Speech-Language Pathology Services 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 no copay for Medicare-covered services, as well as an annual physical exam. Additional preventive services, including Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay. 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 are not covered.
Hearing Services See details
HumanaChoice H5525-075 (PPO) covers hearing services, including hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and Prescription Hearing Aids (all types) have a copay between $699 and $999. OTC hearing aids are covered, with a maximum benefit of $30 every three months.
Vision Services See details
HumanaChoice H5525-075 (PPO) covers vision services, including eye exams with a copay of $0-$25 and eyewear with no copay. Eyeglass lenses, eyeglass frames and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-075 (PPO) offers dental services, including Medicare Dental Services with a $25 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed) with 30% coinsurance, and Oral and Maxillofacial Surgery with no copay. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a $1,000 maximum benefit for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. 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 under the HumanaChoice H5525-075 (PPO) plan, and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the HumanaChoice H5525-075 (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have a 20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the HumanaChoice H5525-075 (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $85, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $350, Therapeutic Radiological Services have a $75 copay, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-075 (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
For the HumanaChoice H5525-075 (PPO) plan, Cardiac Rehabilitation Services are not covered, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HumanaChoice H5525-075 (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, for days 21-39, there is a $203 copay, and for days 40-100, there is no copay.
Other Services See details
Under "Other Services", this HumanaChoice plan covers acupuncture with a $25 copay, but only up to 20 treatments per year and requires prior authorization. Over-the-counter (OTC) items are covered with a maximum benefit of $30 every three months, and this plan also covers nicotine replacement therapy and naloxone. 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, and Self-Directed Personal Assistance Services are not covered.
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