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HumanaChoice H5525-080 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-080 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-080 (PPO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
HumanaChoice H5525-080 (PPO) is a PPO plan offered by Humana Benefit Plan of Illinois, Inc. available for the 2026 plan year to people living in San Joaquin & Stanislaus Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-080 (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 H5525-080 (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 H5525-080 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $5900.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $10100.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 H5525-080 (PPO) Medicare plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, preferred generic drugs require an $8.00 copay at standard pharmacies and preferred mail-order services, or a $20.00 copay for standard mail. Standard generic drugs require a $47.00 copay regardless of whether you use standard retail pharmacies, preferred mail, or standard mail. For brand-name and non-preferred medications, you will pay a percentage-based coinsurance rather than a flat copay. Preferred brand drugs carry a 48% coinsurance, while non-preferred drugs carry a 25% coinsurance across standard retail and mail services. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for your covered Part D prescriptions.
Additional Benefits
The HumanaChoice H5525-080 (PPO) plan offers comprehensive medical coverage with no copay for primary care physician visits, home health services, and routine preventive care. For specialist visits, physical therapy, and occupational therapy, members pay a $35 copay with no coinsurance. Inpatient hospital stays require a $320 daily copay for the first five days, after which there is no copay for days six through ninety. Routine vision and hearing exams are covered with no copay, and the plan features up to $1,500 in annual dental benefits with no copay for preventive services. Emergency room visits carry a $130 copay, while diagnostic lab work and outpatient X-rays are available with no copay. Durable medical equipment is covered with a 15% coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice H5525-080 (PPO) partially covers inpatient hospital services, requiring prior authorization with a $320 copay per day for days 1-5, no copay for days 6-90, and no coinsurance. Additional acute care days are covered with no copay, but non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HumanaChoice H5525-080 (PPO) with no coinsurance, including no copay for ambulatory surgical center and blood services. Patients will pay a copay of $320 per stay for observation services, $0 to $320 for outpatient hospital services, and $25 to $35 per session for outpatient substance abuse services.
Partial Hospitalization See details
HumanaChoice H5525-080 (PPO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HumanaChoice H5525-080 (PPO), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $335 copay and no coinsurance, while air ambulance services require a $630 copay and no coinsurance.
Emergency Services See details
Emergency services are covered by HumanaChoice H5525-080 (PPO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-080 (PPO) covers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $35 copay and no coinsurance. Mental health, psychiatric, and telehealth services are also covered with copays ranging up to $50 and no coinsurance, though podiatry services and routine chiropractic care are not covered.
Preventive Services See details
HumanaChoice H5525-080 (PPO) partially covers preventive services, offering Medicare-covered zero-dollar preventive care, annual physical exams, kidney disease education, and glaucoma screenings with no copay and no coinsurance. However, additional services such as fitness benefits, health education, weight management, alternative therapies, and in-home support are not covered.
Hearing Services See details
HumanaChoice H5525-080 (PPO) covers routine hearing exams and hearing aid fittings with no copay and no coinsurance, while Medicare-covered exams require a $35 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, but inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
HumanaChoice H5525-080 (PPO) provides partially covered vision services with no coinsurance, offering routine eye exams, contact lenses, and eyeglasses with no copay, while other eye exams have a copay of up to $35. Specific sub-services, including individual eyeglass lenses, eyeglass frames, and upgrades, are not covered by the plan.
Dental Services See details
HumanaChoice H5525-080 (PPO) offers partially covered dental services up to a $1,500 annual maximum, though fluoride, implants, maxillofacial prosthetics, and orthodontics are not covered. Preventive care features no copay and no coinsurance, while restorative and prosthodontic services require 30% to 40% coinsurance with no copay, and Medicare-covered dental services require a $35 copay with no coinsurance.
Home Infusion bundled Services See details
HumanaChoice H5525-080 (PPO) covers home infusion bundled services with prior authorization. Medicare Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
HumanaChoice H5525-080 (PPO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered benefits.
Medical Equipment See details
Medical equipment is covered by HumanaChoice H5525-080 (PPO) with a 15% coinsurance and no copay for durable medical equipment (DME), and a 15% coinsurance and no copay for medical supplies. Prosthetic devices require a 20% coinsurance with no copay, while diabetic supplies have a 10% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
HumanaChoice H5525-080 (PPO) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic procedures and tests carry a $0 to $100 copay with no coinsurance, diagnostic radiological services have a $0 to $300 copay with no coinsurance, therapeutic radiological services require a 20% coinsurance with no copay, and lab services and outpatient X-rays feature no copay and no coinsurance.
Home Health Services See details
HumanaChoice H5525-080 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required for these covered services.
Cardiac Rehabilitation Services See details
HumanaChoice H5525-080 (PPO) indicates that some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for covered benefits, which require a copay and no coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by HumanaChoice H5525-080 (PPO) with prior authorization, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100 with no coinsurance. While standard SNF services are covered and do not require a prior three-day inpatient hospital stay, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by HumanaChoice H5525-080 (PPO), as over-the-counter items and dual eligible SNPs are not covered. Covered benefits include acupuncture with a $35 copay and no coinsurance, and limited meal benefits with no copay and no coinsurance.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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