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Humana Gold Choice H8145-091 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-091 (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 H8145-091 (PFFS) in 2025, please refer to our full plan details page.
Humana Gold Choice H8145-091 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Southwest Virginia. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Choice H8145-091 (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 H8145-091 (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 H8145-091 (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. 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 $590.00 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 H8145-091 (PFFS) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For Tier 1 drugs, you'll pay a $17 copay at preferred pharmacies, and a $20 copay at standard pharmacies. For Tier 3 and 4 drugs, you will pay coinsurance of 50% and 25% respectively. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Choice H8145-091 (PFFS) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with copays and coinsurance, and emergency services with copays. The plan also covers primary care, preventive services, and hearing and vision services, often with no copay. Dental services have a $2,000 annual maximum benefit. Additional benefits include ambulance services with a coinsurance, home health services with no copay, and coverage for home infusion and dialysis services with coinsurance. The plan also covers diagnostic and radiological services with copays and coinsurance, along with medical equipment and some other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital-Acute services have a $295 copay for days 1-6, and no copay for days 7-90, while additional days have no copay. Inpatient Hospital Psychiatric services have a $295 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include Outpatient Hospital Services with a $35 copay and 25% coinsurance, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with a minimum coinsurance of 20%, and Outpatient Substance Abuse Services with a minimum copay of $35 and 25% coinsurance. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Choice H8145-091 (PFFS) plan, with a 19% coinsurance.
Ambulance and Transportation Services See details
For Humana Gold Choice H8145-091 (PFFS), Ambulance Services are covered with no copay, but with a 20% coinsurance for both ground and air ambulance services. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Choice H8145-091 (PFFS) plan. Emergency Services have a $100 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $100 copay. There is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Choice H8145-091 (PFFS) plan covers primary care physician services and chiropractic services with a $15 copay, and physician specialist services with a $35 copay. Occupational therapy services have a 20% coinsurance and a $15 copay, while physical therapy and speech-language pathology services have a 20% coinsurance and a $15 copay. Mental health and psychiatric services have a $35 copay, and other health care professional services have a copay between $15 and $35. Additional telehealth benefits have a copay between $0 and $35, and opioid treatment program services have a 25% coinsurance and a $35 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The Humana Gold Choice H8145-091 (PFFS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, kidney disease education services, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit are also covered with no copay.
Hearing Services See details
Hearing exams are covered with a $35 copay. Routine hearing exams are covered with no copay, once per year. Fitting/Evaluation for Hearing Aid has no copay. Prescription hearing aids are partially covered, with only prescription hearing aids (all types) covered, with a copay between $699 and $999, twice per year. OTC hearing aids are covered, with a maximum benefit of $150 per month.
Vision Services See details
Humana Gold Choice H8145-091 (PFFS) covers vision services, including eye exams with a copay of $0-$35, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Choice H8145-091 (PFFS) plan covers dental services, with a maximum benefit of $2,000 per year. Medicare dental services have a $35 copay, and other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Restorative services and fixed prosthodontics have a 30% to 40% coinsurance and no copay, while fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implants, 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 coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs also have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Choice H8145-091 (PFFS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Gold Choice H8145-091 (PFFS) plan. Diagnostic Procedures/Tests have a maximum 25% coinsurance and a maximum copay of $35, while Lab Services have a maximum 25% coinsurance and no copay. Diagnostic Radiological Services have a maximum 25% coinsurance and a maximum copay of $35, Therapeutic Radiological Services have a maximum 20% coinsurance and a maximum copay of $35, and Outpatient X-Ray Services have a maximum 25% coinsurance and a $15 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-091 (PFFS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Humana Gold Choice H8145-091 (PFFS) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some cardiac and pulmonary rehabilitation services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Choice H8145-091 (PFFS). There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $35 copay per visit, and is limited to 20 treatments per year. OTC items are covered up to $150.00 per month. The meal benefit has no copay. Dual Eligible SNPs with Highly Integrated Services are not covered.
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