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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 2026, 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 3.5 out of 5 stars in 2026.
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 $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 $300.00 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 $3950.00 (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 $3950.00 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) Medicare plan features a $300 annual drug deductible. For Tier 1 preferred generic drugs, members pay no copay for one-month or three-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $5 for a one-month supply at standard pharmacies, and there is no copay for a three-month supply filled via preferred mail order. Tier 3 preferred brand drugs cost $47 for a one-month supply, while a three-month supply through preferred mail order is reduced to a $131 copay. For higher-tier prescriptions, members pay a 50% coinsurance on Tier 4 non-preferred drugs and a 29% coinsurance on Tier 5 specialty medications.
Additional Benefits
The Humana Gold Choice H8145-032 (PFFS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care doctor visits, home health services, and covered preventive care. Specialist visits require a $40 copay, while emergency room services have a $150 copay. Inpatient hospital stays are covered with no coinsurance, requiring a $500 daily copay for the first five days of acute care and no copay thereafter. Ancillary benefits include routine hearing and vision exams with no copay, alongside a dental benefit with a $2,000 annual limit and no copay for most covered services. For other healthcare needs, diagnostic lab tests and outpatient X-rays feature no copay, while durable medical equipment and dialysis require a 20% coinsurance. Skilled nursing facility stays require no coinsurance, with a daily copay of $20 for the first 20 days.
Inpatient Hospital See details
Humana Gold Choice H8145-032 (PFFS) covers inpatient hospital services with no coinsurance, though it is only partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. For covered acute stays, you pay a $500 daily copay for days 1 to 5 and no copay thereafter, while psychiatric stays incur a $500 daily copay for days 1 to 4 and no copay for days 5 to 90.
Outpatient Services See details
Humana Gold Choice H8145-032 (PFFS) covers outpatient services with no coinsurance, including outpatient hospital services with a copay ranging from $0 to $500 and observation services with a $500 copay per stay. Outpatient substance abuse sessions have a $35 copay, while ambulatory surgical center and outpatient blood services are covered with no copays.
Partial Hospitalization See details
Humana Gold Choice H8145-032 (PFFS) covers partial hospitalization services with a $35.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Choice H8145-032 (PFFS), which features a $335 copay and no coinsurance for both ground and air ambulance services. Routine transportation services, including trips to plan-approved or any other health-related locations, are not covered.
Emergency Services See details
Emergency Services are covered by Humana Gold Choice H8145-032 (PFFS) with a $150 copay and no coinsurance, while urgently needed services require a $65 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered under this plan with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Choice H8145-032 (PFFS) covers primary care physician visits with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Mental health, psychiatric, and therapy services require copays ranging from $20 to $35 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Choice H8145-032 (PFFS) offers partially covered preventive services with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, memory fitness, and specific screenings. However, Medicare-covered zero-dollar preventive services and various supplemental benefits, including health education, nutritional services, and in-home support, are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Choice H8145-032 (PFFS), featuring a $40 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two aids per year, while inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Humana Gold Choice H8145-032 (PFFS) partially covers vision services, offering routine eye exams and select eyewear with no copay, no coinsurance, and no deductible, though other eye exams may have a copay up to $40. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered, and annual benefits are capped at $75 for exams and $150 for eyewear.
Dental Services See details
Dental Services are partially covered by Humana Gold Choice H8145-032 (PFFS), offering an annual maximum benefit of $2,000. Medicare-covered dental has a $40 copay and no coinsurance, while other covered services have no copay and no coinsurance, except for restorative and fixed prosthodontics which have no copay and 30% to 40% coinsurance. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Choice H8145-032 (PFFS) covers Home Infusion bundled Services with no copay, though associated Medicare Part B chemotherapy, radiation, and other drugs require coinsurance ranging from no coinsurance to 20%. Covered Part B insulin drugs have a $35 copay and up to 20% coinsurance, and step therapy may apply.
Dialysis Services See details
Humana Gold Choice H8145-032 (PFFS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Humana Gold Choice H8145-032 (PFFS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and a 10% to 20% coinsurance from specified manufacturers, while diabetic therapeutic shoes and inserts are covered with a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Choice H8145-032 (PFFS) covers diagnostic and radiological services with no coinsurance for diagnostic tests, no copay for lab services and outpatient X-rays, and diagnostic procedure copays ranging from $0 to $110. Diagnostic radiological services feature copays starting at $0, while therapeutic radiological services require a minimum $30 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Gold Choice H8145-032 (PFFS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Humana Gold Choice H8145-032 (PFFS) provides cardiac rehabilitation services with no copay and no coinsurance, though only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Choice H8145-032 (PFFS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. This benefit is partially covered as additional days beyond the Medicare-covered limit are not covered, though admission does not require a prior three-day inpatient hospital stay.
Other Services See details
Humana Gold Choice H8145-032 (PFFS) provides partial coverage for other services, including acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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