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Humana Gold Choice H8145-032 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-032 (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 H8145-032 (PFFS) in 2025, please refer to our full plan details page.
Humana Gold Choice H8145-032 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Ohio and Indiana. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Choice H8145-032 (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 H8145-032 (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 H8145-032 (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $4150.00 (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 $4150.00 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 H8145-032 (PFFS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, a standard pharmacy visit for a preferred generic drug has a $5.00 copay, and a preferred brand drug has 50% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Choice H8145-032 (PFFS) plan offers a range of benefits, including inpatient hospital stays with a $500 copay for the first few days, and no copay thereafter. Outpatient services have varying copays, and emergency services are covered with copays of $65-$140. The plan also covers primary care, with no copay for primary care physician services. This plan provides coverage for a variety of services, such as vision and dental. Vision services include routine eye exams with no copay and a combined maximum of $150 per year for eyewear. Dental services include a wide range of services with no copay, up to a $2,000 annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits for the Humana Gold Choice H8145-032 (PFFS) plan include coverage for Inpatient Hospital-Acute with a $500 copay for days 1-5, and no copay for days 6-90, as well as Inpatient Hospital Psychiatric with a $500 copay for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $500, observation services have a $500 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay between $40 and $80, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Choice H8145-032 (PFFS) plan. The copay for this benefit is $60.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for ambulance services. Ground and Air Ambulance Services have a $315 copay, while 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. Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services has a $65 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Choice H8145-032 (PFFS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and occupational therapy services have a copay between $20 and $30. Physician specialist services have a $40 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a copay between $40 and $80. Physical therapy and speech-language pathology services have a copay between $20 and $30. Additional telehealth benefits have a copay between $0 and $65. Podiatry services are not covered. Routine chiropractic care is not covered.
Preventive Services See details
The Humana Gold Choice H8145-032 (PFFS) plan covers preventive services, including an annual physical exam with no copay, and additional preventive services for which the copay varies. Also covered are Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. The plan does not cover 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.
Hearing Services See details
Hearing Services are partially covered by the Humana Gold Choice H8145-032 (PFFS) plan, with a $40 copay for hearing exams, but routine hearing exams, fitting/evaluation for hearing aids, and all types of prescription hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
The Humana Gold Choice H8145-032 (PFFS) plan covers vision services, including routine eye exams with a copay of $0 - $40. It also covers eyewear with no copay, and a combined maximum of $150 per year for contact lenses, eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Choice H8145-032 (PFFS) plan covers dental services, including Medicare dental services with a $40 copay. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered. There is a $2,000 maximum plan benefit coverage amount per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. The plan has a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20% for all covered services.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Choice H8145-032 (PFFS) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the Humana Gold Choice H8145-032 (PFFS) plan. Durable Medical Equipment has a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has a coinsurance, while Prosthetic Devices have a 20% coinsurance and no copay. Medical Supplies have a 20% coinsurance and no copay. Diabetic Equipment has a coinsurance and copay, while Diabetic Supplies have a 10% coinsurance and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and radiological services, are covered. Diagnostic Procedures/Tests have a copay ranging from $0 to $110, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $325, Therapeutic Radiological Services have a copay of at most $30 and a coinsurance of 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-032 (PFFS) plan 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 H8145-032 (PFFS) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Choice H8145-032 (PFFS) plan. For days 1-20, there is a $20 copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include acupuncture, which has a $40 copay for up to 20 treatments per year, and a meal benefit with no copay. Over-the-counter items and Dual Eligible SNPs with Highly Integrated Services are not covered.
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