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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 2025, please refer to our full plan details page.
HumanaChoice H5525-080 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in San Joaquin & Stanislaus Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
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 $31.00. 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 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:
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Drug Coverage
The HumanaChoice H5525-080 (PPO) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, generic drugs have a copay between $8 and $47 depending on the pharmacy, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-080 (PPO) plan offers a range of benefits, including inpatient and outpatient hospital care with varying copays. It also covers emergency services, primary care, preventive services, and home health services, often with no copay. This plan provides coverage for hearing and vision services, with copays for exams and no copays for eyewear. Dental services have a $1,000 annual maximum, and many other services, such as ambulance, partial hospitalization, and skilled nursing facilities, are covered with copays.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $320 copay for days 1-5 and no copay for days 6-90, while additional days 91-999 have no copay.
Outpatient Services See details
Outpatient services are covered under the HumanaChoice H5525-080 (PPO) plan. Outpatient Hospital Services have a copay between $0 and $320, while Observation Services have a $320 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services have a copay of $35 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the HumanaChoice H5525-080 (PPO) plan, with a $55 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5525-080 (PPO) plan. Ground Ambulance Services have a copay of $315, and Air Ambulance Services have a copay of $630, with no coinsurance for either. 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 H5525-080 (PPO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a $55 copay and no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay with no coinsurance.
Primary Care See details
The HumanaChoice H5525-080 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. The plan also covers additional telehealth benefits with a copay between $0 and $55. Individual and group sessions for mental health and psychiatric services have a $35 copay.
Preventive Services See details
The HumanaChoice H5525-080 (PPO) plan covers preventive services including an annual physical exam with no copay. This plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit, all with no copay. However, services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $35 copay, routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5525-080 (PPO) plan covers vision services, including eye exams with a copay of $0-$35 and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,000 annual maximum for in-network and out-of-network services. Medicare Dental Services have a $35 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services have no copay. Fluoride Treatment and Orthodontics are not covered. Restorative Services, Prosthodontics (removable and fixed), and Implant Services have a 30% to 40% coinsurance, and Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery have no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, requiring prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment and Diabetic Equipment, is covered by this plan. Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for Diagnostic Procedures/Tests with a copay between $0 and $100, and Lab Services with no copay. Diagnostic Radiological Services have a copay of at most $325, Therapeutic Radiological Services have a copay of at least $75, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-080 (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
HumanaChoice H5525-080 (PPO) covers Cardiac Rehabilitation Services, but does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HumanaChoice H5525-080 (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay; for days 21-49, the copay is $203; and for days 50-100, there is no copay. Additional days beyond Medicare-covered, and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes acupuncture and a meal benefit. Acupuncture has a $35 copay, and is limited to 20 treatments per year. The meal benefit has no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, 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 are not covered.
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