Humana Gold Choice H8145-084 (PFFS)

Humana Gold Choice H8145-084 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Texas. This plan received an overall rating of 3.5 out of 5 stars in 2026.

It's important to know that Humana Gold Choice H8145-084 (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 H8145-084 (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.

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:

Drug Coverage

The Humana Gold Choice H8145-084 (PFFS) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for 1-month and 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs have a $12 copay for a 1-month supply at standard pharmacies and preferred mail order, but there is no copay for a 3-month supply ordered through preferred mail. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, while a 3-month supply costs $141 at standard pharmacies or a reduced $131 through preferred mail order. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 49% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. This tiered cost structure helps beneficiaries understand their potential out-of-pocket expenses based on their specific medication needs.

Additional Benefits

The Humana Gold Choice H8145-084 (PFFS) plan offers comprehensive medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, home health services, and routine annual physicals. Specialist visits require a $40 copay, while inpatient hospital stays have a daily copay of $350 for the first five days of acute care with no coinsurance. Emergency services are covered with a $130 copay, and urgent care visits require a $50 copay. For supplemental care, the plan provides routine vision exams and eyewear up to a $250 annual limit with no copay, alongside dental care covered up to a $1,000 yearly limit with no copay. Routine hearing exams and over-the-counter hearing aids are also available with no copay, while prescribed hearing aids require copays ranging from $399 to $999. Additionally, many diagnostic services, laboratory tests, and outpatient X-rays are covered with no copay or coinsurance.