A non-government entity
HumanaChoice H5525-084 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-084 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-084 (PPO) in 2025, please refer to our full plan details page.
HumanaChoice H5525-084 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2025 to people living in Contra Costa. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that HumanaChoice H5525-084 (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 H5525-084 (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 H5525-084 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.00. 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 $300.00 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 $10000.00 (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 $10000.00 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 H5525-084 (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 H5525-084 (PPO) plan has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay a $10 copay for preferred generic drugs at preferred and mail order pharmacies, and a $20 copay at standard pharmacies. You will pay 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The HumanaChoice H5525-084 (PPO) plan offers coverage for a wide range of services, including inpatient hospital stays, outpatient services, and emergency care. Inpatient hospital stays have a copay that varies depending on the length of stay, while outpatient services have a copay and coinsurance structure. The plan includes no copays for primary care visits, routine hearing exams, and eyewear, as well as preventive and home health services. This plan also covers dental, vision, and hearing services, with specific copays and limitations. Diagnostic and radiological services, medical equipment, and home infusion are also covered. This plan has a $1,000 annual maximum for dental and covers dialysis services with coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For days 1-5 of inpatient hospital stays, there is a $250 copay, and days 6-90 have no copay; additional days 91-999 also have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a coinsurance of 40% and a copay ranging from $0 to $375. Observation Services have a copay of $250. Ambulatory Surgical Center services have no copay, and Outpatient Substance Abuse Services have a $30 copay for both individual and group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $100 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HumanaChoice H5525-084 (PPO) plan. Medicare-covered ground ambulance services have a $315 copay, and Medicare-covered air ambulance services have a $1250 copay; 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 under the HumanaChoice H5525-084 (PPO) plan. Emergency Services have a $125 copay with no coinsurance, while Urgently Needed Services have a $30 copay with no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay with no coinsurance.
Primary Care See details
The HumanaChoice H5525-084 (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, and physician specialist services with a $35 copay. Mental health specialty services and psychiatric services are covered with a $35 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, while additional telehealth benefits have a $0-$35 copay. Opioid treatment program services are covered with a $30 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, Annual Physical Exams, Kidney Disease Education Services, and other preventive services with no copay; however, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. The plan also covers a Fitness Benefit with no copay.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $35 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $499 and $799, while prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The HumanaChoice H5525-084 (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
The HumanaChoice H5525-084 (PPO) plan covers dental services with a $1,000 annual maximum, and a $35 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, while fluoride treatment, maxillofacial prosthetics, implants, 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. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. The coinsurance for other drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the HumanaChoice H5525-084 (PPO) plan, with a coinsurance between 20% and 20%. Prior authorization is required for this service.
Medical Equipment See details
Medical Equipment benefits are covered by the HumanaChoice H5525-084 (PPO) plan. Durable Medical Equipment, Prosthetic Devices, and Medical Supplies have a 9% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a coinsurance of 15%. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the HumanaChoice H5525-084 (PPO) plan, with a copay of up to $40 for Diagnostic Procedures/Tests, no copay for Lab Services, and a copay of up to $300 for Diagnostic Radiological Services. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HumanaChoice H5525-084 (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HumanaChoice H5525-084 (PPO) plan. The plan does not cover additional Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HumanaChoice H5525-084 (PPO), but require prior authorization. For days 1-20, the copay is $10, for days 21-51, the copay is $214, and for days 52-100, there is no copay.
Other Services See details
Other Services includes acupuncture and a meal benefit. Acupuncture has a $35 copay, and a limit of 20 treatments per year. The meal benefit has no copay. Over-the-counter (OTC) 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.
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