A non-government entity
Humana Gold Choice H8145-042 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-042 (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 H8145-042 (PFFS) in 2026, please refer to our full plan details page.
Humana Gold Choice H8145-042 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in 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 H8145-042 (PFFS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Choice H8145-042 (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 H8145-042 (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5900.00 (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 $5900.00 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 H8145-042 (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
Prescription drugs are not covered by Humana Gold Choice H8145-042 (PFFS).
Additional Benefits
The Humana Gold Choice H8145-042 (PFFS) plan offers comprehensive medical coverage with predictable costs, featuring no coinsurance for the majority of standard medical services. Beneficiaries enjoy no copay for primary care doctor visits and covered preventive services, while specialist visits and emergency care require flat copayments. For inpatient hospital stays, you will pay a daily copay for the initial days of your stay and no copay for the remaining covered days. This plan also includes valuable supplemental benefits, such as routine dental and vision care with no copay up to specified annual limits. Routine hearing exams, home health services, and over-the-counter items are also covered with no copay. For specialized needs like durable medical equipment and dialysis, the plan typically charges a twenty percent coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Choice H8145-042 (PFFS) inpatient hospital care is partially covered with no coinsurance, requiring a $345 daily copay for days 1 through 7 of acute stays (with no copay for days 8 and beyond) and a $345 daily copay for days 1 through 5 of psychiatric stays (with no copay for days 6 through 90). Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered under this plan.
Outpatient Services See details
Outpatient services are covered under the Humana Gold Choice H8145-042 (PFFS) plan with no coinsurance, featuring a $0 to $375 copay for hospital services and a $345 copay per stay for observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Humana Gold Choice H8145-042 (PFFS) covers partial hospitalization services with a $35.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Humana Gold Choice H8145-042 (PFFS) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, which is not waived if you are admitted to the hospital. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Choice H8145-042 (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 H8145-042 (PFFS) offers partially covered primary care benefits with no coinsurance for all services, featuring no copay for primary care visits and copays ranging from $15 to $40 for specialists, therapies, and telehealth. Podiatry services are not covered, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Choice H8145-042 (PFFS) preventive services are partially covered with no copay and no coinsurance for annual physicals, kidney disease education, memory fitness, glaucoma screenings, diabetes self-management, digital rectal exams, and EKGs. However, Medicare-covered zero-dollar preventive services and several supplemental benefits—including health education, PERS, in-home safety assessments, medical nutrition therapy, medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, remote access, home modifications, and counseling—are not covered.
Hearing Services See details
Humana Gold Choice H8145-042 (PFFS) covers Medicare-covered hearing exams with a $30 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $99 to $399, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Gold Choice H8145-042 (PFFS) covers vision services with no coinsurance, featuring no copay for one routine eye exam yearly and no copay for eyewear up to a $450 annual limit. This benefit is partially covered, as other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Choice H8145-042 (PFFS), offering covered preventive and comprehensive services with no copay and no coinsurance up to a combined $2,500 annual limit, while Medicare-covered dental services require a $30 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Choice H8145-042 (PFFS) covers home infusion bundled services with no copay and no coinsurance, though step therapy may apply. Associated Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Gold Choice H8145-042 (PFFS) with no copay and a 20% coinsurance.
Medical Equipment See details
Humana Gold Choice H8145-042 (PFFS) covers durable medical equipment, prosthetic devices, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies from specified manufacturers are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Choice H8145-042 (PFFS) covers diagnostic services with no coinsurance, offering lab services at no copay and diagnostic tests with copays ranging from $0 to $120. Covered radiological services include outpatient X-rays and diagnostic radiology with no copay, while therapeutic radiological services require a minimum 20% coinsurance and a $30 copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Choice H8145-042 (PFFS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Humana Gold Choice H8145-042 (PFFS) provides coverage for some Cardiac Rehabilitation Services with no copay and no coinsurance, although standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Choice H8145-042 (PFFS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior three-day inpatient hospital stays are not required for admission, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Choice H8145-042 (PFFS) covers acupuncture with a $30.00 copay and no coinsurance for up to 20 treatments per year. Over-the-counter (OTC) items and qualifying meal benefits are also covered with no copay and no coinsurance, while other additional services in this category 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