A non-government entity
Humana Gold Choice H8145-069 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-069 (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 H8145-069 (PFFS) in 2026, please refer to our full plan details page.
Humana Gold Choice H8145-069 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Georgia and South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Choice H8145-069 (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 H8145-069 (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 H8145-069 (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.00. 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 $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 H8145-069 (PFFS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Choice H8145-069 (PFFS) plan features an annual drug deductible of $615. For Tier 1 preferred generics, you will pay no copay at standard pharmacies and through preferred mail order, while standard mail order costs $10 for a one-month supply. Tier 2 generic drugs have a $5 copay for a one-month supply at standard pharmacies and preferred mail order, with no copay for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at standard pharmacies and mail order options, though a three-month supply via preferred mail order is slightly lower at $131. Tier 4 non-preferred drugs are subject to a 35% coinsurance rate across all pharmacy and mail order channels. For Tier 5 specialty drugs, members pay a 25% coinsurance for a one-month supply at all available pharmacy and mail order options.
Additional Benefits
The Humana Gold Choice H8145-069 (PFFS) plan offers comprehensive medical coverage with predictable costs, including no copay and no coinsurance for primary care visits, home health services, and annual physical exams. Specialist visits require a low $20 copay, while emergency care has a $115 copay with no coinsurance. For inpatient hospital stays, members pay a daily copay of $390 for the first few days and no copay for the remainder of their stay. Routine dental, vision, and hearing services are partially covered with no coinsurance, featuring no copay for routine exams and low copays for eyewear, dental care up to a $4,000 limit, and hearing aids. For specialized needs like durable medical equipment and dialysis, the plan generally charges a 20% coinsurance with no copay. Skilled nursing facility stays are also affordable, requiring no copay for the first 20 days.
Inpatient Hospital See details
Humana Gold Choice H8145-069 (PFFS) covers inpatient hospital care with no coinsurance, but does not cover upgrades, non-Medicare-covered stays, or additional psychiatric days. Acute stays require a $390 daily copay for days 1-6 and no copay for days 7-999, while psychiatric stays require a $390 daily copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Humana Gold Choice H8145-069 (PFFS) covers outpatient services with no coinsurance, featuring a copay ranging from no copay up to $450 for outpatient hospital services and a $390 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Humana Gold Choice H8145-069 (PFFS) covers partial hospitalization services with a $35.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Choice H8145-069 (PFFS), offering ground and air ambulance transportation for a $335 copay and no coinsurance. However, routine transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Humana Gold Choice H8145-069 (PFFS) covers emergency services with a $115 copay and no coinsurance, and urgent care with a $50 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 H8145-069 (PFFS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $20 copay and no coinsurance. Additional benefits include physical, occupational, and speech therapy ($25 to $35 copay), mental health and psychiatric services ($35 copay), and telehealth ($0 to $50 copay), all featuring no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services under Humana Gold Choice H8145-069 (PFFS) are partially covered with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, and select screenings. Sub-services that are not covered include Medicare-covered zero-dollar preventive services, health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, safety modifications, and counseling.
Hearing Services See details
Humana Gold Choice H8145-069 (PFFS) partially covers hearing services, offering Medicare-covered exams for a $20 copay and routine exams or fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with copays ranging from $299 to $599 and no coinsurance, but OTC hearing aids and inner, outer, or over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Choice H8145-069 (PFFS) with no deductibles and no coinsurance. Routine eye exams and eyewear, such as contact lenses and complete eyeglasses, are covered with copays ranging from no copay to $20, while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Choice H8145-069 (PFFS), requiring a $20 copay and no coinsurance for Medicare-covered services, and no copay or coinsurance for other covered services up to a $4,000 annual limit. Non-covered dental services under this plan include fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Humana Gold Choice H8145-069 (PFFS) covers Home Infusion bundled Services with no copay, though associated Medicare Part B chemotherapy and other drugs are subject to a 0% to 20% coinsurance. Medicare Part B insulin drugs are also covered with a $35 copay and 0% to 20% coinsurance, and step therapy may apply.
Dialysis Services See details
Humana Gold Choice H8145-069 (PFFS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Humana Gold Choice H8145-069 (PFFS), featuring a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Choice H8145-069 (PFFS) covers diagnostic and radiological services, offering lab services with no copay or coinsurance and diagnostic procedures with a $0 to $120 copay and no coinsurance. Outpatient x-rays have no copay but require coinsurance, diagnostic radiology has no coinsurance, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Gold Choice H8145-069 (PFFS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Humana Gold Choice H8145-069 (PFFS) covers Cardiac Rehabilitation Services with no copay and no coinsurance, and while some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Choice H8145-069 (PFFS) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. The plan allows for admission with less than a three-day prior inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Choice H8145-069 (PFFS), featuring acupuncture coverage of up to 20 treatments per year with a $20 copay and no coinsurance. Over-the-counter (OTC) items, meal benefits, and other additional services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved