A non-government entity
HumanaChoice H5525-087 (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HumanaChoice H5525-087 (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HumanaChoice H5525-087 (PPO) in 2026, please refer to our full plan details page.
HumanaChoice H5525-087 (PPO) is a PPO plan offered by Humana Inc. available for enrollment in 2026 to people living in San Francisco & Marin Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HumanaChoice H5525-087 (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 H5525-087 (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 H5525-087 (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $67.00. 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 $650.00 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 $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 H5525-087 (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 H5525-087 (PPO) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. During the initial coverage phase, you will pay a $5.00 copay for Tier 1 preferred generics and a $47.00 copay for Tier 2 standard generics at standard pharmacies and preferred mail services. For higher-tier medications, the plan charges a 42% coinsurance for Tier 3 preferred brands and a 25% coinsurance for Tier 4 non-preferred drugs. If you qualify for the Extra Help low-income subsidy, you can benefit from a premium reduction with no copay for your Part D prescription drugs. Once your yearly out-of-pocket drug expenses reach $2,100.00, you will enter the catastrophic coverage phase and pay nothing for covered Part D medications. This plan provides clear cost-sharing phases to help you effectively manage your healthcare budget and prescription costs.
Additional Benefits
HumanaChoice H5525-087 (PPO) offers robust medical coverage with no copay for primary care physician visits, annual physical exams, and select preventive screenings. Inpatient hospital stays require a $225 copay per day for days 1 through 5, after which there is no copay, while emergency care is covered with a $130 copay. Outpatient services vary, featuring no copay for ambulatory surgical center services and a 40 percent coinsurance alongside a $0 to $325 copay for outpatient hospital services. The plan also provides essential specialty benefits, including no copay for routine eye exams, eyeglasses, and routine hearing exams, plus covered dental services up to a $1,000 yearly maximum. Prescription hearing aids are covered with a copay ranging from $499 to $799, and Medicare-covered dental exams require a $45 copay. Additionally, diagnostic labs and home health services are available with no copay, while durable medical equipment is covered with a 15 percent coinsurance and no copay.
Inpatient Hospital See details
HumanaChoice H5525-087 (PPO) partially covers inpatient hospital benefits, requiring a $225 copay for days 1 to 5 and no copay or coinsurance for days 6 to 90, with acute stays covered up to 999 days. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HumanaChoice H5525-087 (PPO) covers outpatient services with no copay for ambulatory surgical center and blood services, and a $25 to $35 copay for outpatient substance abuse sessions. Outpatient hospital services require a 40% coinsurance alongside a $0 to $325 copay, while observation services incur a $225 copay per stay.
Partial Hospitalization See details
HumanaChoice H5525-087 (PPO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HumanaChoice H5525-087 (PPO) partially covers these services, offering ambulance coverage with no coinsurance for a $335 ground copay and a $1,250 air copay, while transportation services to plan-approved or any health-related locations are not covered. Prior authorization is required for all covered ambulance services.
Emergency Services See details
HumanaChoice H5525-087 (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 under a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services require a $130 copay and no coinsurance.
Primary Care See details
HumanaChoice H5525-087 (PPO) offers partially covered Primary Care benefits with no copay or coinsurance for primary care physician visits, while other covered services like specialists, mental health, and therapies require copays ranging from $15 to $50 with no coinsurance. Podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by HumanaChoice H5525-087 (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and select screenings. However, additional services such as fitness benefits, health education, weight management, in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
HumanaChoice H5525-087 (PPO) partially covers hearing services, offering routine hearing exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Up to two prescription hearing aids are covered annually with a $499 to $799 copay and no coinsurance, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HumanaChoice H5525-087 (PPO) offers partially covered vision services with no deductible and no coinsurance. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered with no copay, though other eye exams have a copay of $0 to $45. Separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
HumanaChoice H5525-087 (PPO) partially covers dental services up to a $1,000 yearly maximum, with fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics not covered. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered services have no copay and either no coinsurance or a 30% to 40% coinsurance.
Home Infusion bundled Services See details
HumanaChoice H5525-087 (PPO) covers Home Infusion bundled Services, which require prior authorization and may be subject to step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HumanaChoice H5525-087 (PPO) with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
HumanaChoice H5525-087 (PPO) covers durable medical equipment and medical supplies with a 15% coinsurance and no copay, and prosthetic devices with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay; prior authorization is required for these services.
Diagnostic and Radiological Services See details
HumanaChoice H5525-087 (PPO) covers diagnostic and radiological services, with no copay or coinsurance for lab services and outpatient X-rays. Diagnostic procedures require a copay of $0 to $50 with no coinsurance, diagnostic radiology has a copay of up to $300 with no coinsurance, and therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
HumanaChoice H5525-087 (PPO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HumanaChoice H5525-087 (PPO) plan, as none of the associated sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
HumanaChoice H5525-087 (PPO) partially covers Skilled Nursing Facility (SNF) services with prior authorization, though additional days beyond Medicare-covered stays are not covered. Covered stays require a daily copay of $10 for days 1 to 20 and $218 for days 21 to 100, with no coinsurance.
Other Services See details
HumanaChoice H5525-087 (PPO) partially covers other services, providing acupuncture with a $45 copay and no coinsurance for up to 20 treatments annually, and meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items and dual-eligible SNP 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