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Humana Gold Choice H8145-055 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-055 (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 H8145-055 (PFFS) in 2025, please refer to our full plan details page.
Humana Gold Choice H8145-055 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Pennsylvania. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Choice H8145-055 (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 H8145-055 (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 H8145-055 (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 $6700.00 (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 $6700.00 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 H8145-055 (PFFS)
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Drug Coverage
Prescription drugs are not covered by Humana Gold Choice H8145-055 (PFFS).
Additional Benefits
The Humana Gold Choice H8145-055 (PFFS) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. This plan also provides coverage for primary care, specialist visits, and mental health services, with specific copay amounts for each. Additionally, the plan includes benefits for hearing, vision, and dental services, with some services offered at no copay. The plan covers ambulance, emergency, and home health services, as well as medical equipment and diagnostic services, all with associated costs like copays and coinsurance. Other benefits include coverage for home infusion, dialysis, and skilled nursing facilities. However, this plan does not cover cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For Inpatient Hospital-Acute, you pay a \$390 copay for days 1-5, and no copay for days 6-90; Additional days have no copay. For Inpatient Hospital Psychiatric, you pay a \$390 copay for days 1-4, and no copay for days 5-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $390, observation services with a $390 copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services have a copay between $40 and $95 for individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Choice H8145-055 (PFFS) plan, with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Choice H8145-055 (PFFS) plan. Ground and Air Ambulance Services have a copay of $315, with no coinsurance, while 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 Humana Gold Choice H8145-055 (PFFS). Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $55 copay; all three have no coinsurance.
Primary Care See details
Primary Care services include a $10 copay, while Chiropractic Services have a $15 copay, but routine care is not covered. Occupational therapy services have a copay between $20 and $40. Physician Specialist Services have a $30 copay. Individual and group sessions for Mental Health and Psychiatric services have a $40 copay. Physical Therapy and Speech-Language Pathology Services have a copay between $20 and $40, and Additional Telehealth Benefits have a copay between $0 and $55. Opioid Treatment Program Services have a copay between $40 and $95.
Preventive Services See details
The Humana Gold Choice H8145-055 (PFFS) plan covers preventive services, including an annual physical exam with no copay, and fitness benefits with no copay, but other services like health education, in-home safety assessments, and others are not covered. Other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay of $699-$999, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, with a copay between $0 and $30, and eyewear, both with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include Medicare Dental Services with a $30 copay, Oral Exams with no copay, Dental X-Rays with no copay, Other Diagnostic Dental Services with no copay, Prophylaxis (Cleaning) with no copay, and Other Preventive Dental Services with no copay. Fluoride Treatment, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
The Humana Gold Choice H8145-055 (PFFS) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Choice H8145-055 (PFFS) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the Humana Gold Choice H8145-055 (PFFS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and Diabetic Supplies have a 10% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Choice H8145-055 (PFFS) plan. Diagnostic Procedures/Tests have a copay between $0 and $105, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, Therapeutic Radiological Services have a copay up to $30 and coinsurance up to 20%, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-055 (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 by the Humana Gold Choice H8145-055 (PFFS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Choice H8145-055 (PFFS) plan. You will pay a copay of $10 for days 1-20, and a copay of $214 for days 21-100.
Other Services See details
For Humana Gold Choice H8145-055 (PFFS), the Other Services benefit covers acupuncture with a $30 copay, and meal benefits with no copay, while over-the-counter items and dual eligible SNPs with highly integrated services are not covered. Acupuncture is limited to 20 treatments per year.
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