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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 2026, 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 2026.
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 $1.00. 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 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 $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) Medicare plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible during the initial coverage phase, Tier 1 preferred generic drugs require a $5.00 copay at standard pharmacies and preferred mail, while Tier 2 standard generic drugs carry a $47.00 copay. For higher-tier medications, you will pay a 42% coinsurance for Tier 3 preferred brands and a 25% coinsurance for Tier 4 non-preferred drugs. If you qualify for the low-income subsidy, your Part D cost-sharing is reduced to no copay. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions. This plan provides structured and predictable costs to help you manage your healthcare budget.
Additional Benefits
The HumanaChoice H5525-075 (PPO) plan offers robust healthcare coverage with no copay or coinsurance for essential services like primary care visits, preventive care, home health services, and routine dental exams up to a $1,750 annual limit. For specialized medical care, members pay predictable copays, including $30 for specialists, $150 for emergency room visits, and a $350 daily copay for the first five days of inpatient hospital stays. While many outpatient and diagnostic services feature no copay, other medical needs such as durable medical equipment and dialysis require a 15% to 20% coinsurance with no copay. Additionally, members can take advantage of valuable extra benefits like no-copay routine eye and hearing exams, alongside covered over-the-counter items and acupuncture.
Inpatient Hospital See details
HumanaChoice H5525-075 (PPO) partially covers inpatient hospital benefits, with acute and psychiatric stays requiring a $350 daily copay for days 1 through 5 and no copay or coinsurance for days 6 through 90. While unlimited additional acute days are covered at no copay or coinsurance, non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5525-075 (PPO) covers outpatient services with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services and a $350 copay per stay for observation services. Covered ambulatory surgical center and blood services have no copays, while outpatient substance abuse sessions require a $25 to $35 copay.
Partial Hospitalization See details
HumanaChoice H5525-075 (PPO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by the HumanaChoice H5525-075 (PPO) plan, featuring a $335 copay and no coinsurance for both ground and air ambulance services. However, transportation services to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
Emergency services are covered by HumanaChoice H5525-075 (PPO) 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 $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-075 (PPO) covers primary care visits with no copay and specialist visits with a $30 copay, both with no coinsurance. Therapy services require a $20 copay and mental health services cost a $25 copay with no coinsurance, while chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine chiropractic care. Podiatry services are not covered under this plan.
Preventive Services See details
HumanaChoice H5525-075 (PPO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. However, this benefit is only partially covered, excluding 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 benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
HumanaChoice H5525-075 (PPO) covers hearing services with no coinsurance, featuring a $30 copay for Medicare-covered exams and no copay for annual routine exams, fittings, and OTC hearing aids. Prescription hearing aids are partially covered with copays ranging from $699 to $999, but inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
HumanaChoice H5525-075 (PPO) features partially covered vision services with no deductible and no coinsurance, though prior authorization is required. Routine eye exams and combined eyewear packages have no copay up to annual maximums of $40 and $300 respectively, while other exams require a copay up to $30; however, standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-075 (PPO) offers partially covered dental services with an annual maximum of $1,750, featuring no copay and no coinsurance for most preventive and comprehensive care. Medicare-covered dental services require a $30 copay and no coinsurance, while fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
HumanaChoice H5525-075 (PPO) covers home infusion bundled services with prior authorization, offering chemotherapy, radiation, and other Part B drugs with no copay and coinsurance ranging from no coinsurance to 20%. Medicare Part B insulin drugs are also covered under this benefit, requiring a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
HumanaChoice H5525-075 (PPO) covers Dialysis Services with 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5525-075 (PPO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with prior authorization required for most services. DME is covered with a 15% coinsurance and no copay, while prosthetic devices require a 20% coinsurance and medical supplies require a 15% coinsurance. Diabetic supplies require a 20% coinsurance and no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5525-075 (PPO), with prior authorization required for all services. Lab services and outpatient X-rays feature no copay or coinsurance, diagnostic procedures cost up to an $85 copay with no coinsurance, diagnostic radiology ranges from no copay to a $300 copay, and therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
HumanaChoice H5525-075 (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H5525-075 (PPO) plan, as no sub-services are covered in practice, including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-075 (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
HumanaChoice H5525-075 (PPO) partially covers other services, as the meal benefit and dual eligible SNPs with highly integrated services are not covered. Covered acupuncture requires a $30 copay and no coinsurance for up to 20 treatments per year, while over-the-counter items are covered with no copay and no coinsurance.
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