A non-government entity
Humana Gold Choice H8145-006 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-006 (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 H8145-006 (PFFS) in 2025, please refer to our full plan details page.
Humana Gold Choice H8145-006 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Multi-State. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Choice H8145-006 (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 H8145-006 (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 H8145-006 (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.00. 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 $590.00 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 $7000.00 (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 $7000.00 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 Humana Gold Choice H8145-006 (PFFS)
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 Humana Gold Choice H8145-006 (PFFS) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, a preferred generic drug has a $15 copay at preferred pharmacies and $20 at standard pharmacies. For preferred brand drugs, you will pay 50% coinsurance. Non-preferred drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Choice H8145-006 (PFFS) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll find no copays for primary care, preventive services, and many dental services, as well as some hearing and vision services. The plan also covers services like ambulance, emergency care, and home health with copays or coinsurance. This plan provides additional coverage for areas such as hearing and vision, with some services like hearing exams and eyewear having no copay. It also includes benefits for dental, home infusion, and medical equipment, with copays or coinsurance depending on the specific service. While the plan covers many services, it's important to note that some services like cardiac rehabilitation and certain hearing aids are not covered.
Inpatient Hospital See details
Inpatient hospital services are covered, including acute and psychiatric care. For acute care, you'll pay a $230 copay for days 1-7, and no copay for days 8-90, while additional days 91-999 have no copay; non-Medicare covered stays and upgrades are not covered. For psychiatric care, you'll pay a $230 copay for days 1-7, and no copay for days 8-90, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $350, and for observation services with a $230 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay between $45 and $95 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Choice H8145-006 (PFFS) plan, with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Choice H8145-006 (PFFS) plan, with ground ambulance services subject to a $315 copay, and air ambulance services subject to 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Choice H8145-006 (PFFS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all services have no coinsurance.
Primary Care See details
The Humana Gold Choice H8145-006 (PFFS) plan covers primary care physician services with no copay and chiropractic services with a $15 copay. Occupational therapy services have a $35 copay, while physician specialist services have a $55 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a copay between $45 and $95, and physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay between $0 and $55. Podiatry services are not covered.
Preventive Services See details
The Humana Gold Choice H8145-006 (PFFS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services such as Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $55 copay, routine hearing exams with no copay for 1 visit per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for prescription hearing aids of all types, while inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Choice H8145-006 (PFFS) plan covers vision services, including eye exams with a copay ranging from $0 to $55, and eyewear with no copay. Eyeglass lenses, eyeglass frames and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $55 copay for Medicare dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics (removable and fixed) are covered, with a $0 copay, but some services have a coinsurance of 30-40%. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Choice H8145-006 (PFFS) plan, including Medicare Part B Insulin Drugs with a $35 copay and between 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Choice H8145-006 (PFFS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Humana Gold Choice H8145-006 (PFFS) plan covers Durable Medical Equipment with a 20% coinsurance, and Prosthetic Devices and Medical Supplies with a 20% coinsurance and no copay. Diabetic Equipment is covered, with a 10% coinsurance for Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Gold Choice H8145-006 (PFFS) plan. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $350, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-006 (PFFS) plan with no copay and no coinsurance. However, 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 H8145-006 (PFFS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Choice H8145-006 (PFFS), with no copay for days 1-20 and a $203 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Choice H8145-006 (PFFS) plan covers acupuncture with a $55 copay, and a meal benefit with no copay. Over-the-counter items and Dual Eligible SNPs with Highly Integrated 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