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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 2025, 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 4 out of 5 stars in 2025.
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 $7550.00 (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 $7550.00 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
Prescription drugs are not covered by Humana Gold Choice H8145-042 (PFFS).
Additional Benefits
The Humana Gold Choice H8145-042 (PFFS) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $460, and partial hospitalization with an $80 copay. Emergency services, primary care, and preventive services have copays that vary or have no copay. This plan also covers hearing, vision, and dental services, with varying copays and some services covered at no cost. This plan also includes coverage for ambulance, home health, and skilled nursing facility services. Home infusion, dialysis, medical equipment, and diagnostic services are covered with copays and/or coinsurance. Additional benefits include coverage for some other services, such as acupuncture, OTC items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $345 copay for days 1-5, and no copay for days 6-90, with no coinsurance. Additional days for Inpatient Hospital-Acute have no copay, and no coinsurance. Inpatient Hospital Psychiatric services have a $345 copay for days 1-4, and no copay for days 5-90, with no coinsurance. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $0 to $375, observation services with a copay of $460, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay of $45 to $100 for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Choice H8145-042 (PFFS) plan, with an $80 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $315 copay for both ground and air ambulance services and no 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 by the Humana Gold Choice H8145-042 (PFFS) plan. Emergency Services has a $110 copay and no coinsurance, Urgently Needed Services has a $45 copay and no coinsurance, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay and no coinsurance.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $15 copay. Occupational Therapy Services have a $15-$35 copay, and Physician Specialist Services have a $40 copay. Mental Health Specialty Services have a $45 copay for both individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $15-$35 copay, and Additional Telehealth Benefits have a $0-$45 copay. Opioid Treatment Program Services have a $45-$100 copay. Routine Chiropractic Care is not covered, and Podiatry Services are also not covered.
Preventive Services See details
The Humana Gold Choice H8145-042 (PFFS) plan covers annual physical exams with no copay, and also covers additional preventive services, including Fitness Benefit (Memory Fitness), with no copay. Some services, such as Health Education, are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but specific types such as inner ear, outer ear, and over the ear are not covered. OTC hearing aids are covered with a maximum benefit of $150 every three months.
Vision Services See details
The Humana Gold Choice H8145-042 (PFFS) plan covers vision services, including eye exams with a copay between $0 and $40. Eyewear, including contact lenses and eyeglasses (lenses and frames), are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Choice H8145-042 (PFFS) covers Medicare Dental Services with a $40 copay and other dental services, including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, and oral and maxillofacial surgery with no copay, with a $2,000 maximum plan benefit. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Choice H8145-042 (PFFS) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Humana Gold Choice H8145-042 (PFFS). Diagnostic Procedures/Tests have a copay between $0 and $120, 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 $40 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-042 (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 covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but the exact cost is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Choice H8145-042 (PFFS) plan, with no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture with a $40 copay, over-the-counter (OTC) items with a maximum benefit of $150 every three months, and a meal benefit with no copay. Dual Eligible SNPs with Highly Integrated Services are not covered.
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