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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 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Humana Gold Choice H8145-004 (PFFS) is a PFFS plan offered by Humana Insurance Company available for the 2026 plan year to people living in North Carolina and Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
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 $7.00. 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
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7550.00 (in-network and out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $7550.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
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 Humana Gold Choice H8145-004 (PFFS)
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Drug Coverage
The Humana Gold Choice H8145-004 (PFFS) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for 1-month and 3-month supplies at standard pharmacies or through preferred mail order. Tier 2 generic drugs are also very affordable, with a $5 copay for a 1-month supply and no copay for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and mail order services. For higher-tier medications, Tier 4 non-preferred drugs carry a 30% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Choice H8145-004 (PFFS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, while specialist visits require a $40 copay. For emergency needs, there is a $115 copay for emergency room visits and a $40 copay for urgent care. Inpatient hospital stays feature no coinsurance but require a $330 daily copay for the first eight days of acute stays. Beneficiaries also enjoy no copays or coinsurance for routine vision exams, preventive dental care up to a $2,000 annual limit, and routine hearing exams. Outpatient diagnostic lab services and home health services are available with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. This plan features no deductible for vision and hearing services, helping to keep your out-of-pocket costs predictable.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Gold Choice H8145-004 (PFFS) with no coinsurance, featuring a $330 daily copay for days 1 through 8 of acute stays and days 1 through 5 of psychiatric stays. There is no copay for additional acute days or psychiatric days 6 through 90, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Choice H8145-004 (PFFS) with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital visits require a copay ranging from no copay up to $450, including a $330 copay per stay for observation services, while outpatient substance abuse sessions have a $25 to $35 copay.
Partial Hospitalization See details
Humana Gold Choice H8145-004 (PFFS) covers partial hospitalization services to support your mental health needs. Covered individuals will pay a $35.00 copay and no coinsurance for these services.
Ambulance and Transportation Services See details
Humana Gold Choice H8145-004 (PFFS) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance per service. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Choice H8145-004 (PFFS) emergency services are covered with a $115 copay and no coinsurance, while urgently needed services require a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Choice H8145-004 (PFFS) covers primary care visits with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Covered therapy, mental health, psychiatric, and telehealth services require copays ranging from $0 to $40 with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Gold Choice H8145-004 (PFFS) offers partial coverage for preventive services with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, fitness benefits, glaucoma screenings, diabetes self-management training, digital rectal exams, and EKGs following a welcome visit. However, Medicare-covered zero-dollar preventive services are not covered, nor are supplemental services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, extra smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Choice H8145-004 (PFFS) covers hearing services with no coinsurance and no deductible, featuring a $40 copay for Medicare-covered exams and no copay for annual routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with a copay ranging from $99 to $399 for up to two devices per year, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by the Humana Gold Choice H8145-004 (PFFS) plan with no deductible, no coinsurance, and no copay for covered services, which include one routine eye exam and one pair of eyeglasses or contact lenses per year. This benefit is partially covered, as other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered under the plan's annual limits of $75 for exams and $250 for eyewear.
Dental Services See details
Humana Gold Choice H8145-004 (PFFS) partially covers dental services, offering most preventive and comprehensive care with no copay and no coinsurance up to a $2,000 annual limit, while Medicare-covered dental services require a $40 copay and no coinsurance. Specific services that are not covered under this plan include fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Humana Gold Choice H8145-004 (PFFS) covers Home Infusion bundled Services with no copay, while associated Medicare Part B chemotherapy, radiation, and other Part B drugs require coinsurance ranging from no coinsurance to 20%. Medicare Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%, and step therapy may apply.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Choice H8145-004 (PFFS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Humana Gold Choice H8145-004 (PFFS) covers durable medical equipment and prosthetics with a 20% coinsurance and no copay. Covered diabetic supplies feature a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Choice H8145-004 (PFFS) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $120 copay for diagnostic procedures. Covered radiological services include diagnostic radiology and outpatient X-rays with no copay, while therapeutic radiological services require a minimum $40 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Choice H8145-004 (PFFS) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Humana Gold Choice H8145-004 (PFFS) does not cover Cardiac Rehabilitation Services in practice, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all listed as not covered. While the plan features no coinsurance, these individual rehabilitation services require copayments ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Choice H8145-004 (PFFS) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior inpatient hospital stays of three days are not required for admission, but additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other services are partially covered under Humana Gold Choice H8145-004 (PFFS), featuring acupuncture up to 20 treatments yearly for a $40 copay and no coinsurance. Over-the-counter items and chronic illness meal benefits are covered with no copay and no coinsurance, while Other 1, Other 2, Other 3, and highly integrated dual eligible SNP services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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