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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 2026, 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 2026.
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.
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 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 $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:
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Drug Coverage
The HumanaChoice H5525-077 (PPO) Medicare plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay a $5.00 copay for Tier 1 preferred generics at standard pharmacies and preferred mail order, or a $20.00 copay via standard mail. Tier 2 standard generics cost a $47.00 copay, while Tier 3 preferred brands and Tier 4 non-preferred drugs require 37% and 25% coinsurance, respectively. These cost-sharing rates apply during the initial coverage phase until your total yearly drug costs reach $2,100.00, at which point you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Furthermore, beneficiaries who qualify for the Extra Help low-income subsidy will benefit from a premium reduction resulting in no cost for Part D.
Additional Benefits
The HumanaChoice H5525-077 (PPO) plan offers comprehensive medical coverage with no copay for primary care visits and a $30 copay for specialist visits. For hospital care, inpatient stays require a $320 daily copay for days one through five with no copay for days six through 90, while outpatient hospital services range from no copay to a $350 copay. Emergency room visits are covered with a $130 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes key supplemental benefits, such as routine vision and hearing exams with no copay and dental coverage up to a $2,500 annual maximum. Skilled nursing facility care requires a $10 daily copay for the first 20 days, and home health services are covered with no copay or coinsurance. Durable medical equipment is covered with a 15% coinsurance, while dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by HumanaChoice H5525-077 (PPO), requiring a $320 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance for acute and psychiatric stays. Unlimited additional acute care days are covered with no copay, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5525-077 (PPO) with no coinsurance. Costs range from no copay for ambulatory surgical center and blood services, a $25 to $35 copay for outpatient substance abuse services, no copay to a $350 copay for outpatient hospital services, and a $320 copay per stay for observation services.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the HumanaChoice H5525-077 (PPO) plan with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HumanaChoice H5525-077 (PPO) offers partial coverage for ambulance and transportation services, featuring a $335 copay for ground ambulance and a $630 copay for air ambulance, with no coinsurance for either. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HumanaChoice H5525-077 (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are available for a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services each require a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits are covered by HumanaChoice H5525-077 (PPO) with no copay for primary care visits and a $30 copay for specialists, both with no coinsurance. Other services like therapies, mental health, and telehealth have copays ranging from $0 to $50 and no coinsurance, though chiropractic services are only partially covered (routine chiropractic care is not covered) and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice H5525-077 (PPO) with no copays or coinsurance for covered services such as annual physicals, memory fitness, and kidney disease education. Excluded services that are not covered include health education, safety assessments, PERS, 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, bathroom safety devices, and counseling.
Hearing Services See details
HumanaChoice H5525-077 (PPO) covers hearing services with no deductible, including Medicare-covered exams for a $30 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, while inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
HumanaChoice H5525-077 (PPO) partially covers vision services with no deductible and no coinsurance, offering one routine eye exam and eyewear like contact lenses or eyeglasses per year with no copay. Other eye exams require a copay of up to $30, while individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5525-077 (PPO) up to a $2,500 annual maximum, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Covered Medicare dental services require a $30 copay and no coinsurance, while most preventive and comprehensive services have no copay and no coinsurance, except for fixed and removable prosthodontics which require a 30% coinsurance and no copay.
Home Infusion bundled Services See details
HumanaChoice H5525-077 (PPO) covers home infusion bundled services, including chemotherapy, insulin, and other Part B drugs, subject to prior authorization and step therapy. Covered Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs require no copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5525-077 (PPO) with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
HumanaChoice H5525-077 (PPO) covers durable medical equipment and medical supplies with a 15% coinsurance and no copay. Prosthetic devices and diabetic supplies are covered with a 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance. Prior authorization is required for these covered medical equipment benefits.
Diagnostic and Radiological Services See details
HumanaChoice H5525-077 (PPO) covers diagnostic and radiological services with prior authorization. Lab services and outpatient X-rays have no copay or coinsurance, diagnostic procedures carry a $0 to $85 copay, diagnostic radiology has a $0 to $300 copay, and therapeutic radiology requires a 20% coinsurance.
Home Health Services See details
HumanaChoice H5525-077 (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 HumanaChoice H5525-077 (PPO) because all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered, resulting in no copay or coinsurance coverage for these services.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-077 (PPO) partially covers Skilled Nursing Facility (SNF) care, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by the HumanaChoice H5525-077 (PPO) plan, which offers acupuncture for a $30 copay and no coinsurance for up to 20 treatments per year with prior authorization. Over-the-counter items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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