Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H5525-086

Medicare Plan

HumanaChoice H5525-086 (PPO) · Humana · Local PPO · Select Counties in Pennsylvania

Full CMS plan ID: H5525-086-002

H5525-086-002 is the full CMS identifier for the H5525-086 Medicare plan. Common searches include H5525 086 and H5525086.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

HumanaChoice H5525-086 (PPO)

H5525-086-002 Select Counties in Pennsylvania Local PPO

At-a-glance

Quick view

01

In-network

Inpatient hospital

Per admission $325 per stay
Plan-listed inpatient copay $325
02

Emergency transport

Ambulance

Ground · in-network$335 copay
Air · in-network$335 copay
03

Emergency services

Emergency room

$130 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$6,050
Combined in + out$6,050
05

Skilled care at home

Home health

In-network$0 copay
Out-of-network$0 copay
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$29 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-network$0 copay
Out-of-network$0 copay

Specialist

In-network$15 copay
Out-of-network$15 copay

Preventive care

In-network$0 copay
Out-of-network$0 copay
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-network$0–$105 copay
Out-of-network$0–$105 copay

Laboratory services

In-network$0–$50 copay
Out-of-network$0–$50 copay

X-rays & standard imaging

In-network$0–$780 copay
Out-of-network$0–$780 copay

MRI, CT & PET imaging

In-network$30 copay + 20% coinsurance
Out-of-network$30 copay + 20% coinsurance
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$130 copay
Out-of-networkNot separately reported

Ground ambulance

In-network$335 copay
Out-of-network$335 copay

Air ambulance

In-network$335 copay
Out-of-network$335 copay

Outpatient hospital

In-network$0–$400 copay
Out-of-network$0–$400 copay

Outpatient surgery / ASC

In-network$0–$300 copay
Out-of-network$0–$300 copay
Recovery & therapy5 benefits

Home health

In-network$0 copay
Out-of-network$0 copay

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-network$10–$15 copay
Out-of-network$10–$15 copay

Occupational therapy

In-network$20–$30 copay
Out-of-network$20–$30 copay

Physical & speech therapy

In-network$20–$30 copay
Out-of-network$20–$30 copay
Behavioral health2 benefits

Mental health services

In-network$35 copay
Out-of-network$35 copay

Substance use treatment

In-network$35 copay
Out-of-network$35 copay
Specialty care2 benefits

Podiatry

In-network$15 copay
Out-of-network$15 copay

Chiropractic

In-network$15 copay
Out-of-network$20 copay
Supplemental benefits7 benefits

Dental

In-network$15 copay
Out-of-network$15 copay

Vision

In-network$0 copay
Out-of-network$0 copay

Hearing

In-network$0 copay
Out-of-network$0 copay

Transportation

In-network$0 copay
Out-of-network$0 copay

Fitness & wellness

In-network$0 copay
Out-of-network$0 copay

Over-the-counter allowance

In-network$0 copay
Out-of-network$0 copay

Meals

In-network$0 copay
Out-of-network$0 copay
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$6,050
Combined in + out$6,050

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

Local PPO · Referrals: Not required · Out-of-network coverage: Yes

Prescription drugs5 tiers

Part D deductible

Not reported

Drug tier 1

$0 retail copay · 30-day supply

Drug tier 2

$5 retail copay · 30-day supply

Drug tier 3

$47 retail copay · 30-day supply

Drug tier 4

47% retail coinsurance · 30-day supply

Drug tier 5

25% retail coinsurance · 30-day supply

Using this plan

Understand H5525-086-002

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

HumanaChoice H5525-086 (PPO) is a 2026 Local PPO offered by Humana in Select Counties in Pennsylvania. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals. Its listed inpatient copay stages total $325 across null charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
$0 copay
Specialist
$15 copay
Laboratory services
$0–$50 copay

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
$0–$105 copay
MRI, CT & PET imaging
$30 copay + 20% coinsurance
Outpatient hospital
$0–$400 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$130 copay
Listed inpatient stages
$325 total

null charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Select Counties in Pennsylvania (PA)
Plan type
Local PPO
Contract / plan
H5525-086
Coverage year
2026

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental$15 copay
Vision$0 copay
Hearing$0 copay
Over-the-counter allowance$0 copay
Fitness & wellness$0 copay
Transportation$0 copay
Meals$0 copay

Plan-specific answers

Frequently asked questions

Where is H5525-086-002 available?

HumanaChoice H5525-086 (PPO) is listed for Select Counties in Pennsylvania (PA). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the in-network maximum out-of-pocket limit for H5525-086-002?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $6,050. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H5525-086-002?

The listed consolidated Part C and Part D premium is $29 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H5525-086-002?

The plan record lists $130 copay, waived when an admission meets the plan's stated timing rule.

Does H5525-086-002 report extra benefits?

Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H5525-086-002 fits

Full CMS plan ID
H5525-086-002
Contract
H5525
Base plan code
H5525-086
Segment
002
Carrier
Humana
Plan type
Local PPO
Service area
Select Counties in Pennsylvania (PA)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Adams, PA
  • Bedford, PA
  • Berks, PA
  • Blair, PA
  • Bradford, PA
  • Centre, PA
  • Chester, PA
  • Clinton, PA
  • Cumberland, PA
  • Dauphin, PA
  • Delaware, PA
  • Fulton, PA

23 additional service-area entries are retained in the data record.

Same CMS contract

H5525-086-001 HumanaChoice H5525-086 (PPO) Pittsburgh & Western Pennsylvania · Local PPO H5525-005-000 HumanaChoice H5525-005 (PPO) Select Counties in Pennsylvania & West Virginia · Local PPO H5525-006-000 HumanaChoice H5525-006 (PPO) South Central Pennsylvania area · Local PPO H5525-051-001 HumanaChoice H5525-051 (PPO) Select Counties in Pennsylvania · Local PPO H5525-051-002 HumanaChoice H5525-051 (PPO) Greater Philadelphia · Local PPO H5525-059-000 Humana USAA Honor Giveback with Rx (PPO) Select counties in Pennsylvania · Local PPO H5525-085-001 HumanaChoice Giveback H5525-085 (PPO) Pittsburgh & Western Pennsylvania · Local PPO H5525-085-002 HumanaChoice Giveback H5525-085 (PPO) Select Counties in Pennsylvania · Local PPO

About this code

What H5525-086-002 identifies

H5525-086-002 is a Contract Year 2026 Medicare plan segment code. Searches written as H5525-086, H5525 086, or the compact full CMS ID H5525086002 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.