A non-government entity
HumanaChoice H5525-077 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-077 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-077 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-077 (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 H5525-077 (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 H5525-077 (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 H5525-077 (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 $8900.00 (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 $8900.00 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:
Sign up for HumanaChoice H5525-077 (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HumanaChoice H5525-077 (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you'll pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The HumanaChoice H5525-077 (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services can have copays ranging from $0 to $295. The plan includes coverage for emergency, primary care, preventive, hearing, vision, and dental services, with many services having no copay. This plan also covers ambulance, home health, and skilled nursing facility services, along with diagnostic and radiological services. Additional benefits include home infusion, dialysis, and medical equipment coverage with coinsurance. Other services like acupuncture and over-the-counter items are also covered, with specific copays or coverage limits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5, there is a $295 copay, but for days 6-90, there is no copay; additional days for Inpatient Hospital-Acute have no copay, while additional days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, offered by HumanaChoice H5525-077 (PPO), include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay of $0-$295, while observation services have a copay of $295. Ambulatory surgical center services and outpatient blood services have no copay, and outpatient substance abuse services have a copay of $20.
Partial Hospitalization See details
Partial Hospitalization is covered by the HumanaChoice H5525-077 (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5525-077 (PPO) plan. Ground Ambulance Services have a $315 copay, and Air Ambulance Services have a $630 copay, with 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 under the HumanaChoice H5525-077 (PPO) plan. Emergency Services has a $120 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Services has a $120 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay and require prior authorization, but routine care is not covered. Occupational Therapy Services require prior authorization and have a $20 copay. Physician Specialist Services have a $30 copay. Mental Health and Psychiatric Services have a $20 copay. Physical Therapy and Speech-Language Pathology Services have a $20 copay and require prior authorization. Additional Telehealth Benefits have a copay between $0 and $30. Opioid Treatment Program Services have a $20 copay and require prior authorization.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, Annual Physical Exams with no copay, and additional preventive services. Additional preventive services, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
HumanaChoice H5525-077 (PPO) covers hearing services, including hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $699 and $999, and OTC hearing aids are covered up to $30 every three months.
Vision Services See details
Vision Services include eye exams with a copay of $0-$30, and eyewear with no copay, with coverage including routine eye exams, contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-077 (PPO) offers dental services with a $2,500 annual maximum, including a $30 copay for Medicare Dental Services and no copay for Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, and Oral and Maxillofacial Surgery. Prosthodontics, removable and fixed, have a 30% coinsurance, while Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-077 (PPO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
The HumanaChoice H5525-077 (PPO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires prior authorization. Prosthetic Devices and Medical Supplies are covered with a 20% coinsurance, and Diabetic Equipment is covered with a 20% coinsurance for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. There is no copay for Diabetic Supplies, and a copay applies for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay ranging from $0 to $85, and lab services with no copay. Diagnostic radiological services have a maximum copay of $300, 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 H5525-077 (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any specific cardiac rehabilitation services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-077 (PPO) plan. For days 1-20, there is a $10 copay, for days 21-48, there is a $203 copay, and for days 49-100, there is no copay.
Other Services See details
The HumanaChoice H5525-077 (PPO) plan covers acupuncture with a $30 copay, and over-the-counter (OTC) items with a maximum benefit coverage amount of $30 every three months. This plan does not cover meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, or other services, including 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved