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Humana Gold Choice H8145-004 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-004 (PFFS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Choice H8145-004 (PFFS) in 2025, please refer to our full plan details page.
Humana Gold Choice H8145-004 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in North Carolina-Virginia. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Choice H8145-004 (PFFS) 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 Humana Gold Choice H8145-004 (PFFS).
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 Humana Gold Choice H8145-004 (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.00. 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 does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $350.00 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 $7550.00 (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 $7550.00 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 Humana Gold Choice H8145-004 (PFFS) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for preferred generic drugs, you will pay a $15 copay at preferred and standard mail order pharmacies, and a $20 copay at a standard pharmacy. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Choice H8145-004 (PFFS) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have copays that vary by the service. Emergency services have a $100 copay. The plan provides coverage for primary care and specialist visits with copays, as well as preventive, hearing, vision, and dental services. Hearing exams and routine eye exams have copays, and the plan covers hearing aids. Dental services have no copay for many services. This plan also offers coverage for ambulance and transportation, and also includes coverage for home infusion, dialysis, medical equipment, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For acute inpatient hospital stays, you pay a $330 copay for days 1-6, and no copay for days 7-90, while additional days have no copay; for psychiatric inpatient hospital stays, you pay a $345 copay for days 1-4, and no copay for days 5-90. Non-Medicare-covered stays and upgrades for acute and additional days for psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by Humana Gold Choice H8145-004 (PFFS), including outpatient hospital services with a copay between $0 and $375, observation services with a $330 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $45 and $100 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Choice H8145-004 (PFFS) plan. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered with no coinsurance, but have a $300 copay for both ground and air ambulance services. Transportation services to plan-approved health-related locations are covered for 24 one-way trips per year with no copay, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Choice H8145-004 (PFFS) plan. Emergency Services have a $100 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $100 copay and no coinsurance.
Primary Care See details
Humana Gold Choice H8145-004 (PFFS) covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $15-$35 copay, and specialist services with a $45 copay. Mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services are also covered with varying copays. Routine chiropractic care is not covered.
Preventive Services See details
The Humana Gold Choice H8145-004 (PFFS) plan covers preventive services, including annual physical exams with no copay, as well as additional preventive services, kidney disease education services, and other preventive services with no copay for glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Medicare-covered zero-dollar preventive services, 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.
Hearing Services See details
Humana Gold Choice H8145-004 (PFFS) covers hearing exams with a $45 copay, and routine hearing exams with no copay for one visit every year. Fitting/evaluation for hearing aids has no copay, and prescription hearing aids have a copay between $99 and $399 for 2 visits every year, although specific hearing aid types are not covered. OTC hearing aids are covered up to a $30 maximum benefit every month.
Vision Services See details
The Humana Gold Choice H8145-004 (PFFS) plan covers vision services, including routine eye exams with a copay between $0 and $45, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Choice H8145-004 (PFFS) covers a variety of dental services, including Medicare Dental Services with a $45 copay, 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 with no copay. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. There is a maximum plan benefit of $2000 per year for Other Dental Services.
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 under the Humana Gold Choice H8145-004 (PFFS) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while other services have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Choice H8145-004 (PFFS) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment has a 10-20% coinsurance for Diabetic Supplies with no copay, and a $10 copay for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Humana Gold Choice H8145-004 (PFFS). Diagnostic Procedures/Tests have a copay between $0 and $120, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $325, and Therapeutic Radiological Services have a copay of at most $45 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Choice H8145-004 (PFFS) 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 Humana Gold Choice H8145-004 (PFFS) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Choice H8145-004 (PFFS) plan. There is no copay for days 1-20 and days 63-100, but there is a $184 copay for days 21-62.
Other Services See details
Other Services include coverage for acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $45 copay per visit, and is limited to 20 treatments per year. OTC items are covered up to $30 per month, and the amount carries forward if unused. The meal benefit has no copay. Dual Eligible SNPs with Highly Integrated Services are not covered.
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