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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 2026, 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 3.5 out of 5 stars in 2026.
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 comprehensive coverage with no copay and no coinsurance for primary care doctor visits, routine preventive services, home health care, and cardiac rehabilitation. For specialist visits, patients will pay a $30 copay, while inpatient hospital stays require a $390 daily copay for the first few days before transitioning to no copay. Emergency room visits carry a $130 copay, and outpatient services range from no copay up to a $415 copay depending on the specific service. This plan also features partial coverage for dental, vision, and hearing services, offering routine eye exams, routine hearing exams, and select dental care with no copay. While durable medical equipment and dialysis services require a 20% coinsurance, skilled nursing facility stays are covered with daily copays starting at $10 for the first 20 days. Additionally, home infusion services are available with no copay, though associated Medicare Part B drugs may require up to a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Choice H8145-055 (PFFS) covers inpatient hospital services with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $390 daily copay for days 1 to 5 (with no copay for days 6 and beyond), while psychiatric stays require a $390 daily copay for days 1 to 4 (with no copay for days 5 to 90).
Outpatient Services See details
Humana Gold Choice H8145-055 (PFFS) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and outpatient blood services. Medicare-covered outpatient hospital services require a copay of $0 to $415, including a $390 copay per stay for observation services, while outpatient substance abuse individual and group sessions carry a $35 copay.
Partial Hospitalization See details
Humana Gold Choice H8145-055 (PFFS) covers partial hospitalization services with a $35.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Humana Gold Choice H8145-055 (PFFS), featuring a $315 copay and no coinsurance for ground and air ambulance services. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Choice H8145-055 (PFFS) with a $130 copay and no coinsurance, while urgently needed services require a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Choice H8145-055 (PFFS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, and speech therapies require a $20 to $40 copay, while mental health, psychiatric, and opioid treatment sessions have a $35 copay, all with no coinsurance. Telehealth benefits feature a $0 to $50 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Gold Choice H8145-055 (PFFS) partially covers preventive services, providing an annual physical exam, kidney disease education, memory fitness, and screenings for glaucoma and diabetes with no copay and no coinsurance. However, Medicare-covered zero-dollar preventive services and supplemental benefits like health education, in-home safety assessments, and nutritional therapy are not covered under this plan.
Hearing Services See details
Humana Gold Choice H8145-055 (PFFS) partially covers hearing services with no deductibles and no coinsurance. Medicare-covered exams require a $30 copay, while routine exams and fitting evaluations have no copay. Up to two prescription hearing aids are covered yearly with copays ranging from $699 to $999, but OTC, 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 H8145-055 (PFFS), offering routine eye exams and select eyewear with no copay and no coinsurance, up to annual limits of $75 and $200 respectively with no deductibles. Other eye exam services, standalone eyeglass lenses, standalone frames, and upgrades are not covered by the plan.
Dental Services See details
Humana Gold Choice H8145-055 (PFFS) provides partially covered dental services with a $30.00 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Choice H8145-055 (PFFS) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%. Medicare Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%, and step therapy requirements may apply.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Choice H8145-055 (PFFS) with no copay and a 20% coinsurance.
Medical Equipment See details
Humana Gold Choice H8145-055 (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 and coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Choice H8145-055 (PFFS) with no coinsurance for diagnostic services, no copay for lab or outpatient X-ray services, and diagnostic procedure copays ranging from $0 to $105. Diagnostic radiological services feature a $0 minimum copay, while therapeutic radiological services require a minimum $30 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Choice H8145-055 (PFFS) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Humana Gold Choice H8145-055 (PFFS) offers Cardiac Rehabilitation Services with no copay and no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Choice H8145-055 (PFFS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. While a prior three-day hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Choice H8145-055 (PFFS) partially covers other services, featuring acupuncture for a $30 copay and no coinsurance up to 20 treatments per year, and meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter items and other supplemental services are not covered under this plan.
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