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Humana Gold Choice H8145-052 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-052 (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 H8145-052 (PFFS) in 2026, please refer to our full plan details page.
Humana Gold Choice H8145-052 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in KY, PA, WV. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Choice H8145-052 (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 H8145-052 (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 H8145-052 (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.
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 $7100.00 (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 $7100.00 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 H8145-052 (PFFS) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a 1-month supply, or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, which can be reduced to a $131 copay for a 3-month supply through preferred mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 44% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Choice H8145-052 (PFFS) plan offers comprehensive medical coverage with affordable cost-sharing, featuring no copay for primary care physician visits and a $45 copay for specialists. Inpatient hospital stays require a $325 daily copay for the first 5 to 6 days and no copay for subsequent days, while emergency care has a $115 copay. Most preventive services, home health care, and outpatient lab work are fully covered with no copay and no coinsurance. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing services with no copay for routine exams, eyeglasses, and select hearing aids. Additionally, members can access up to 36 free one-way transportation trips to plan-approved locations each year. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, ensuring reliable support for ongoing medical needs.
Inpatient Hospital See details
Humana Gold Choice H8145-052 (PFFS) partially covers inpatient hospital services with no coinsurance, excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Medicare-covered acute stays require a $325 daily copay for days 1-6 and no copay for days 7 and beyond, while psychiatric stays require a $325 daily copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Humana Gold Choice H8145-052 (PFFS) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $305, observation services cost a $325 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Humana Gold Choice H8145-052 (PFFS) covers partial hospitalization services. Members will pay a $35.00 copay and no coinsurance for these covered services.
Ambulance and Transportation Services See details
Humana Gold Choice H8145-052 (PFFS) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 36 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Choice H8145-052 (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 H8145-052 (PFFS) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Additional services like mental health, physical therapy, and telehealth feature copays ranging from no copay to $45 with no coinsurance, though chiropractic benefits are only partially covered since other chiropractic services are not covered.
Preventive Services See details
Humana Gold Choice H8145-052 (PFFS) offers coverage for select preventive services, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, EKGs following a welcome visit, and a memory fitness benefit, all with no copay and no coinsurance. However, Medicare-covered zero-dollar preventive services and various supplemental benefits, such as health education and in-home support, are not covered.
Hearing Services See details
Hearing services under Humana Gold Choice H8145-052 (PFFS) include routine hearing exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $45 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $0 to $299 and no coinsurance for up to two aids every three years, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Humana Gold Choice H8145-052 (PFFS), featuring routine eye exams, contact lenses, and eyeglasses (lenses and frames) with no copay, no coinsurance, and no deductible. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Choice H8145-052 (PFFS), with Medicare-covered dental requiring a $45 copay and no coinsurance, and other covered dental services requiring no copay and no coinsurance up to a $1,750 annual limit. Sub-services that are not covered under this plan include fluoride treatments, orthodontics, implant services, maxillofacial prosthetics, and removable prosthodontics.
Home Infusion bundled Services See details
Humana Gold Choice H8145-052 (PFFS) covers Home Infusion bundled Services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance. Part B insulin is covered with a $35 copay and between no coinsurance and 20% coinsurance, with step therapy requirements applying.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Choice H8145-052 (PFFS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Humana Gold Choice H8145-052 (PFFS) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Choice H8145-052 (PFFS) covers diagnostic and radiological services with no coinsurance for diagnostic services and no copay for lab services or outpatient X-rays. Diagnostic procedures and tests carry a copay of $0 to $105, while therapeutic radiological services require a minimum $45 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Gold Choice H8145-052 (PFFS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided with no copay and no coinsurance under Humana Gold Choice H8145-052 (PFFS), though some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Choice H8145-052 (PFFS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. A prior three-day hospital stay is not required for admission, but additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Humana Gold Choice H8145-052 (PFFS) offers partially covered other services, which include acupuncture with a $45 copay and no coinsurance up to 20 treatments per year, plus over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Certain additional services, specifically Other 1, Other 2, and Other 3, are not covered under this plan.
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