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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 2026, 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 2026.
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 $70.00. 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. 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 $10100.00 (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 $10100.00 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 H5525-084 (PPO) Medicare plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, Tier 1 preferred generic drugs require a $5.00 copay at standard pharmacies and preferred mail, while Tier 2 standard generics cost a $47.00 copay. Tier 3 preferred brands and Tier 4 non-preferred drugs carry a 41% and 25% coinsurance respectively. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for covered Part D drugs. Additionally, individuals who qualify for the full low-income subsidy pay no premium for Part D coverage.
Additional Benefits
The HumanaChoice H5525-084 (PPO) plan offers robust coverage designed to minimize your out-of-pocket expenses for everyday medical needs. You will pay no copay or coinsurance for primary care doctor visits, routine vision and hearing exams, home health care, and annual physicals. For specialized medical services, the plan features a predictable $35 copay for specialist visits, physical therapy, and Medicare-covered dental care. For emergency and inpatient care, this plan provides clear, structured costs to help you plan your healthcare budget. Emergency room visits carry a $130 copay, which is waived upon admission, while inpatient hospital stays require a $380 daily copay for the first five days. Additionally, you will receive valuable extra benefits including a $1,000 annual dental limit, partial coverage for prescription hearing aids, and routine eyewear coverage.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HumanaChoice H5525-084 (PPO), requiring a $380 daily copay for days 1 to 5 and no copay or coinsurance for days 6 to 90 for acute and psychiatric stays. Upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered under this plan.
Outpatient Services See details
HumanaChoice H5525-084 (PPO) covers outpatient services with costs ranging from no copay and no coinsurance for ambulatory surgical center and blood services, to a $25 to $35 copay and no coinsurance for outpatient substance abuse sessions. Outpatient hospital services require a $0 to $425 copay and 40% coinsurance, while observation services carry a $380 copay per stay with no coinsurance.
Partial Hospitalization See details
HumanaChoice H5525-084 (PPO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required for these covered mental health services.
Ambulance and Transportation Services See details
HumanaChoice H5525-084 (PPO) covers ambulance services with no coinsurance, requiring prior authorization and a copay of $335 for ground transport and $1,250 for air transport. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
HumanaChoice H5525-084 (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-084 (PPO) covers primary care physician visits with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy require a $35 copay and no coinsurance. Additional benefits like mental health, psychiatric, and telehealth services are covered with copays ranging from $0 to $50 and no coinsurance, though chiropractic care is only partially covered with routine chiropractic excluded, and podiatry is not covered.
Preventive Services See details
Preventive services are covered by HumanaChoice H5525-084 (PPO) with no copays or coinsurance for annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Additional preventive services are only partially covered, featuring a memory fitness benefit with no copay or coinsurance, while other programs like health education, weight management, and home safety assessments are not covered.
Hearing Services See details
HumanaChoice H5525-084 (PPO) covers routine hearing exams and fitting evaluations with no deductible, no copay, and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $899 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
HumanaChoice H5525-084 (PPO) covers routine eye exams and eyewear with no copay, no coinsurance, and no deductible, up to annual limits of $75 and $200 respectively, while other eye exams have a copay up to $35 with no coinsurance or deductible. Eyewear is partially covered, with contact lenses and eyeglasses (lenses and frames) included, but individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by HumanaChoice H5525-084 (PPO) up to a $1,000 annual limit, excluding fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered services feature no copay and either no coinsurance or 30% to 40% coinsurance.
Home Infusion bundled Services See details
HumanaChoice H5525-084 (PPO) covers home infusion bundled services, which require prior authorization and step therapy. Medicare Part B insulin drugs are covered with a $35 copay and up to 20% coinsurance (with a minimum of no coinsurance), while chemotherapy, radiation, and other Part B drugs require no copay and up to 20% coinsurance (with a minimum of no coinsurance).
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5525-084 (PPO) with no copay and a 20% coinsurance. Prior authorization is required to access these covered services.
Medical Equipment See details
HumanaChoice H5525-084 (PPO) covers durable medical equipment (DME) with a 15% coinsurance and no copay, and prosthetics or medical supplies with a 15% to 20% coinsurance and no copay. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HumanaChoice H5525-084 (PPO) with prior authorization, featuring no copay and no coinsurance for lab services and outpatient X-rays. Diagnostic procedures require a $0 to $50 copay with no coinsurance, diagnostic radiological services have a $0 to $300 copay with no coinsurance, and therapeutic radiological services carry a 20% coinsurance with no copay.
Home Health Services See details
HumanaChoice H5525-084 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H5525-084 (PPO) plan, as none of the individual sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-084 (PPO) partially covers Skilled Nursing Facility (SNF) services, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance. Prior authorization is required, and additional days beyond Medicare-covered SNF services are not covered.
Other Services See details
HumanaChoice H5525-084 (PPO) partially covers Other Services, offering acupuncture for up to 20 treatments per year with a $35 copay and no coinsurance, alongside meal benefits with no copay and no coinsurance. Over-the-Counter (OTC) items and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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