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Humana Gold Choice H8145-084 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-084 (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 H8145-084 (PFFS) in 2025, please refer to our full plan details page.
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 4 out of 5 stars in 2025.
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.
For Humana Gold Choice H8145-084 (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $4.00. You must continue to pay paying your reduced 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 $250.00 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 H8145-084 (PFFS) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, for a standard generic drug you will pay a $12 copay at a standard pharmacy, while preferred brand drugs have a 46% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Choice H8145-084 (PFFS) plan offers a wide range of benefits, including coverage for inpatient and outpatient hospital services. You'll have copays for services like inpatient stays, outpatient visits, and emergency care, while some services like preventive care and home health have no copay. This plan also provides coverage for hearing, vision, and dental services, with varying copays and coverage limits. Additionally, you'll find coverage for ambulance services, durable medical equipment, and home infusion services, with some services subject to coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-5, and no copay for days 6-90; additional days 91-999 have no copay. Inpatient Hospital Psychiatric services have a $318 copay for days 1-5, and no copay for days 6-90; 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 of $45-$325, observation services with a $325 copay, and ambulatory surgical center services with a $225 copay. The plan also covers outpatient substance abuse services with a copay of $30-$50 for individual or group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Choice H8145-084 (PFFS) plan with a $45 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 H8145-084 (PFFS) plan, which includes both ground and air ambulance services. Ground ambulance services have a $265 copay, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered, including emergency services, urgently needed services, and worldwide emergency services. Emergency services and worldwide emergency coverage have a $90 copay, while urgently needed services have a $55 copay; there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Choice H8145-084 (PFFS) plan covers Primary Care Physician Services with a $10 copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $40 copay, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. Mental Health and Psychiatric Services have a $30 copay for individual and group sessions, while Opioid Treatment Program Services have a copay between $30 and $50. Additional Telehealth Benefits are covered with a copay between $0 and $55. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Humana Gold Choice H8145-084 (PFFS) plan covers preventive services including an annual physical exam with no copay, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. However, Medicare-covered preventive services, health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams are covered with no copay. Prescription hearing aids are partially covered; Prescription Hearing Aids (all types) are covered with a copay between $399 and $999, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC hearing aids are covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$40, routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered. Contact lenses and eyeglasses (lenses and frames) are covered.
Dental Services See details
Dental services are covered, with a $1,000 maximum benefit per year. Medicare dental services have a $40 copay. Other services include oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, other preventive dental services with no copay, restorative services with no copay, adjunctive general services with no copay, endodontics with no copay, periodontics with no copay, prosthodontics fixed with no copay, and oral and maxillofacial surgery with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Gold Choice H8145-084 (PFFS) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Choice H8145-084 (PFFS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered under this plan. DME has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance, while Diabetic Supplies have a 10-20% coinsurance with no copay and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The Humana Gold Choice H8145-084 (PFFS) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $55, and lab services with no copay. Outpatient X-ray services have a $10 copay, and therapeutic radiological services have a copay of at least $40 and coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-084 (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 H8145-084 (PFFS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Choice H8145-084 (PFFS) plan. There is no copay for days 1-20, and a $172 copay for days 21-100.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $40 copay per visit, and is limited to 20 treatments per year. OTC items are covered up to $40 per month and carry forward if unused, and the meal benefit has no copay.
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