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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 2025, 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 4 out of 5 stars in 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced 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 $360.00 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) plan has a $360 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, you will pay a $17 copay at preferred mail and standard pharmacies, and a $20 copay at standard mail pharmacies. For standard generic drugs, the copay is $47, regardless of the pharmacy. For preferred brand drugs, you pay 50% coinsurance, and for non-preferred drugs, you pay 28% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Choice H8145-052 (PFFS) plan offers a range of benefits, including inpatient hospital care with a $325 copay for the first few days and no copay thereafter, and outpatient services with varying copays. The plan covers primary care with no copay, and covers a variety of other services such as hearing, vision, and dental, with copays and coverage limits for some services. Emergency services, ambulance, and transportation services are covered with copays.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-6, and no copay for days 7-90, and for days 91-999, there is no copay. For Inpatient Hospital Psychiatric, you pay a $325 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $280, Observation Services with a $325 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $40 and $100 for both individual and group sessions, and Outpatient Blood Services with no copay. The plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Choice H8145-052 (PFFS) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Choice H8145-052 (PFFS) plan. Ground and Air Ambulance Services have a copay of $290, while Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year using a taxi, bus/subway, or medical transport. Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Choice H8145-052 (PFFS) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all have no coinsurance.
Primary Care See details
The Humana Gold Choice H8145-052 (PFFS) plan covers primary care physician services with no copay. Chiropractic services, including routine care, have a $15 copay. Occupational therapy services have a copay between $20 and $35. Physician specialist services have a $45 copay. Mental health specialty services, including individual and group sessions, have a $40 copay. Podiatry services have a $45 copay. Other health care professionals have a copay between $0 and $45. Psychiatric services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a copay between $20 and $35. Additional telehealth benefits have a copay between $0 and $45. Opioid treatment program services have a copay between $40 and $100.
Preventive Services See details
The Humana Gold Choice H8145-052 (PFFS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services such as Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay, but other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
The Humana Gold Choice H8145-052 (PFFS) plan covers hearing services, including hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $199 and $799, while OTC hearing aids are covered up to $100 every three months.
Vision Services See details
Vision services include eye exams with a copay between $0 and $45, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered, and there is a combined maximum of $150 for eyewear per year.
Dental Services See details
Dental Services are covered under Humana Gold Choice H8145-052 (PFFS), with a maximum benefit of $1,000 per year. Medicare dental services have a $45 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics fixed, and oral and maxillofacial surgery have no copay. Fluoride treatment, prosthodontics removable, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, are covered by Humana Gold Choice H8145-052 (PFFS). For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Choice H8145-052 (PFFS) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment includes coverage for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, with no copay. Prosthetic Devices and Medical Supplies have a 20% coinsurance, with no copay. Diabetic Supplies have a 10% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $105, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $300.00, while Therapeutic Radiological Services have a coinsurance of at most 20% and a copay of at most $45.00. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-052 (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 under the Humana Gold Choice H8145-052 (PFFS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Choice H8145-052 (PFFS) plan. For days 1-20, there is no copay, but for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $45 copay per treatment, and is limited to 20 treatments per year. OTC items are covered with a maximum benefit of $100 every three months, and the plan offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as a Part C OTC benefit. The meal benefit has no copay. Dual Eligible SNPs with Highly Integrated Services are not covered.
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