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HumanaChoice H5525-076 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-076 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-076 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-076 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in San Diego. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-076 (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 H5525-076 (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 H5525-076 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.00. 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 $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 H5525-076 (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, you'll pay a $2 copay for preferred generic drugs at a standard or preferred mail pharmacy, or a $20 copay at a standard mail pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. This plan may offer a premium reduction if you qualify for the low-income subsidy (LIS). Check the plan's formulary for specific drug coverage details.
Additional Benefits
The HumanaChoice H5525-076 (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay for the first few days, but no copay for the rest of the stay. Outpatient services have copays, and other services like ambulance, emergency care, primary care, preventive services, hearing, vision, and dental services all have specific copays or coinsurance amounts. This plan also covers home health services with no copay, and skilled nursing facility stays with a copay for the first few days. Diagnostic and radiological services, along with medical equipment and dialysis services, have copays or coinsurance. Remember that prior authorization is often required for certain services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care. For acute care, you'll pay a $225 copay for days 1-5, and no copay for days 6-90, with no coinsurance; additional days for acute care have no copay or coinsurance. For inpatient psychiatric care, you'll pay a $225 copay for days 1-5, and no copay for days 6-90, with no coinsurance.
Outpatient Services See details
Outpatient Services for HumanaChoice H5525-076 (PPO) include coverage for Outpatient Hospital Services with a copay between $0 and $225, Observation Services with a $225 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions. Outpatient Blood Services are also covered with no copay, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-076 (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, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, and air ambulance services have a $630 copay, but 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 by the HumanaChoice H5525-076 (PPO) plan. Emergency Services have a $120 copay and no coinsurance, Urgently Needed Services have a $30 copay and no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $120 copay and no coinsurance.
Primary Care See details
The HumanaChoice H5525-076 (PPO) plan covers Primary Care Physician Services with no copay. Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services have a $15-$20 copay. Additional Telehealth Benefits have a copay between $0-$30. Podiatry Services are not covered.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services with a copay that varies by service. Kidney disease education services, Glaucoma screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit are covered with no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $15 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 $399 and $699, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5525-076 (PPO) plan covers vision services, including eye exams with a copay of $0-$15 and eyewear with no copay. Contact lenses and eyeglasses are covered with no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered. Medicare dental services have a $15 copay. Other dental services include oral exams with no copay, and dental x-rays with no copay. Prosthodontics, removable and fixed have a 30% coinsurance with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. There is a 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Medical Supplies and Prosthetic Devices have a 20% coinsurance, and Diabetic Supplies have a 20% coinsurance and no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by HumanaChoice H5525-076 (PPO), including diagnostic procedures and tests with a copay between $0 and $85, lab services with no copay, diagnostic radiological services with a copay up to $300, therapeutic radiological services with a copay of $75, and outpatient X-ray services with no copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-076 (PPO) plan with no copay and no coinsurance, but 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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and there is a copay for some services; see the plan details for more information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-076 (PPO) plan, with a $10 copay for days 1-20, a $203 copay for days 21-39, and no copay for days 40-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture with a $15 copay, but has a limit of 20 treatments per year and requires prior authorization. Other services such as over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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