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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 2026, 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 3.5 out of 5 stars in 2026.
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 $37.00. 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 $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 $6800.00 (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 $6800.00 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 H8145-006 (PFFS) Medicare prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. For Tier 2 generic medications, you will pay a $5 copay for a 1-month supply at standard pharmacies, while a 3-month supply through preferred mail order has no copay. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail-order options. Higher-tier prescriptions carry coinsurance rates instead of flat copays, with Tier 4 non-preferred drugs requiring 34% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance for a 1-month supply. These structured copays and coinsurance rates help you easily estimate your out-of-pocket prescription costs with this Humana plan.
Additional Benefits
The Humana Gold Choice H8145-006 (PFFS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care physician visits, while specialist visits require a $55 copay. Inpatient hospital stays require daily copays of $360 for acute care and $297 for psychiatric care during the first seven days, followed by no copay for the remaining covered days. Emergency care is available with a $115 copay, while urgent care visits require a $40 copay. For supplemental care, the plan features no copay and no coinsurance for routine vision and hearing exams, alongside dental coverage up to a $3,000 annual limit with no copay and 0% to 40% coinsurance. Skilled nursing facility stays have no copay for the first 20 days, and home health services are covered with no copay and no coinsurance. Durable medical equipment and dialysis services are also covered, requiring a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Choice H8145-006 (PFFS) covers inpatient hospital care with no coinsurance, requiring a $360 daily copay for days 1 to 7 of acute stays and a $297 daily copay for days 1 to 7 of psychiatric stays, followed by no copay for remaining covered days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Choice H8145-006 (PFFS) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital copays range from $0 to $300, while observation services cost a $360 copay per stay and outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Gold Choice H8145-006 (PFFS) for a $35.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance services are covered by Humana Gold Choice H8145-006 (PFFS), featuring a $335 copay for ground ambulance services and a 20% coinsurance for air ambulance services, with neither cost waived upon hospital admission. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Humana Gold Choice H8145-006 (PFFS) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with 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 H8145-006 (PFFS) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Physical, occupational, and speech therapy services cost a $35 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Choice H8145-006 (PFFS) partially covers preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, glaucoma screenings, and a memory fitness benefit. However, Medicare-covered zero-dollar preventive services and various supplemental benefits, such as health education, nutritional therapy, and in-home safety assessments, are not covered.
Hearing Services See details
Humana Gold Choice H8145-006 (PFFS) covers Medicare-covered hearing exams with a $55 copay and no coinsurance, while routine exams and fitting evaluations have no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 and no coinsurance for up to two devices per year, but inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Humana Gold Choice H8145-006 (PFFS) provides partially covered vision services with no copay and no coinsurance for covered benefits, which include one routine eye exam (up to $75) and one pair of contact lenses or eyeglasses (up to $100) per year. Other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Gold Choice H8145-006 (PFFS) partially covers dental services up to a $3,000 annual limit, featuring no copay and 0% to 40% coinsurance for most covered services, while Medicare-covered dental requires a $55 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by Humana Gold Choice H8145-006 (PFFS) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance. Medicare Part B insulin is also covered under this benefit with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Choice H8145-006 (PFFS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Humana Gold Choice H8145-006 (PFFS) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Choice H8145-006 (PFFS) with no coinsurance and no copay for lab services, alongside diagnostic procedures that carry a copay of $0 to $95. Radiological services require a minimum 20% coinsurance, with outpatient X-rays featuring no copay and diagnostic radiological services offering copays starting at $0.
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.
Cardiac Rehabilitation Services See details
Humana Gold Choice H8145-006 (PFFS) offers Cardiac Rehabilitation Services with no coinsurance, though only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered, carrying copayments ranging from $15 to $30.
Skilled Nursing Facility (SNF) See details
Humana Gold Choice H8145-006 (PFFS) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Choice H8145-006 (PFFS) partially covers other services, offering acupuncture with a $55.00 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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