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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 2025, 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 4 out of 5 stars in 2025.
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 $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 $340.00 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:
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Drug Coverage
The Humana Gold Choice H8145-069 (PFFS) plan has a $340 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, for a standard pharmacy, you'll pay a $17 copay for a preferred generic drug, or 50% coinsurance for a preferred brand drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, also known as LIS or "Extra help", you will pay $0.00 for Part D.
Additional Benefits
The Humana Gold Choice H8145-069 (PFFS) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays depending on the length of stay, and outpatient services have copays that vary by service. Emergency services, primary care visits, and preventive services may have copays, while some services like home health and lab services have no copay. This plan also includes coverage for hearing and vision services, with copays for exams and some hearing aids. Dental services are covered with a copay, offering a maximum benefit per year. Additionally, the plan covers home infusion, dialysis, medical equipment, and diagnostic services, each with specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital-Acute has a copay of $390 for days 1-5, and no copay for days 6-90, with no coinsurance. Additional Days for Inpatient Hospital-Acute has no copay and no coinsurance for days 91-999. Inpatient Hospital Psychiatric has a copay of $587 for days 1-3, and no copay for days 4-90, with no coinsurance. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $415, observation services with a $390 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a copay between $60 and $100 for individual and group sessions, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Choice H8145-069 (PFFS) plan, with an $80 copay. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Choice H8145-069 (PFFS) plan. Medicare-covered ground and air ambulance services have a $300 copay 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 under the Humana Gold Choice H8145-069 (PFFS) plan. Emergency Services and Worldwide Emergency Coverage have a $100 copay, while Urgently Needed Services have a $55 copay, and there is no coinsurance for any of these services. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $100 copay.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $20 copay, though routine care is not covered. Occupational Therapy Services have a copay between $25 and $35, and Physician Specialist Services have a $20 copay. Mental Health Specialty Services have a $60 copay for individual and group sessions. Podiatry Services and Other Health Care Professional have a copay between $20 and $20. Physical Therapy and Speech-Language Pathology Services have a copay between $25 and $35, and Additional Telehealth Benefits have a copay between $0 and $60. Opioid Treatment Program Services have a copay between $60 and $100.
Preventive Services See details
The Humana Gold Choice H8145-069 (PFFS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Some preventive services, such as Health Education, are not covered.
Hearing Services See details
Hearing exams are covered with a $20 copay. Routine hearing exams are covered with no copay, and are limited to one exam per year. Fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered with a copay between $299 and $599 for two hearing aids every year, while Inner Ear, Outer Ear, and Over the Ear hearing aids are not covered. OTC hearing aids are covered with a maximum benefit of $250 every three months.
Vision Services See details
The Humana Gold Choice H8145-069 (PFFS) plan covers vision services, including routine eye exams with a copay between $0 and $20, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Choice H8145-069 (PFFS) covers Medicare dental services with a $20 copay, and other dental services with a $2,500 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Choice H8145-069 (PFFS) plan. The coinsurance for these services is between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Choice H8145-069 (PFFS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices have a 20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic supplies have a 10% coinsurance with no copay, and 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 H8145-069 (PFFS) plan. Diagnostic Procedures/Tests have a copay between $0 and $120, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $495, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-069 (PFFS) plan with no copay and no coinsurance, but 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 H8145-069 (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 H8145-069 (PFFS) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for acupuncture with a $20 copay, over-the-counter (OTC) items up to $250 every three months, and a meal benefit with no copay. Dual Eligible SNPs with Highly Integrated Services are not covered.
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