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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 2026, 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 3.5 out of 5 stars in 2026.
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 $15.00. 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 $6500.00 (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 $6500.00 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 features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $5 for a 1-month supply at standard pharmacies and preferred mail order, and you pay no copay for a 3-month supply via preferred mail order. Tier 3 preferred brand drugs generally require a $47 copay for a 1-month supply at standard pharmacies and mail order channels. For higher-tier medications, Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance.
Additional Benefits
The Humana Gold Choice H8145-091 (PFFS) plan provides robust medical coverage with no copay or coinsurance for primary care physician visits and home health services. For acute inpatient hospital stays, members pay a $295 daily copay for days 1 through 6 and no copay for additional days. Emergency care is available worldwide for a $130 copay, while specialist visits and outpatient mental health services require a $35 copay. In addition to core medical care, this plan features dental coverage up to a $2,000 annual maximum with no copay for preventive services, alongside routine vision and hearing exams with no copay. Prescription hearing aids are covered with copays ranging from $699 to $999, while over-the-counter hearing aids require no copay. Skilled nursing facility care is also covered, requiring no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Humana Gold Choice H8145-091 (PFFS) covers inpatient hospital care with no coinsurance, requiring a $295 daily copay for days 1-6 of acute stays (no copay for days 7 and beyond) and days 1-5 of psychiatric stays (no copay for days 6-90). Non-Medicare-covered stays, upgrades, and psychiatric additional days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Choice H8145-091 (PFFS), featuring outpatient hospital services with a copay ranging from no copay to $35 and a 25% coinsurance, and observation services for a $295 copay per stay. Ambulatory surgical center services require no copay and a 20% coinsurance, while outpatient substance abuse sessions have a $35 copay with no coinsurance, and blood services carry no copay or coinsurance.
Partial Hospitalization See details
Humana Gold Choice H8145-091 (PFFS) covers partial hospitalization services with a $35.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Humana Gold Choice H8145-091 (PFFS) covers Medicare-approved ground and air ambulance services with a 20% coinsurance and no copay, and this coinsurance is not waived if you are admitted to the hospital. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Choice H8145-091 (PFFS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Choice H8145-091 (PFFS) offers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, psychiatric, and opioid treatment services have a $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $15 copay and 20% coinsurance, telehealth services feature a $0 to $50 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services under the Humana Gold Choice H8145-091 (PFFS) plan are partially covered with no copays and no coinsurance for an annual physical exam, kidney disease education, fitness benefits, in-home support, and select screenings. However, Medicare-covered zero-dollar preventive services and various supplemental programs like health education and nutritional therapy are not covered.
Hearing Services See details
Hearing services covered by Humana Gold Choice H8145-091 (PFFS) include exams with a $35 copay for Medicare-covered visits, no copay for routine exams, and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, excluding inner ear, outer ear, and over the ear types, while over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Choice H8145-091 (PFFS) partially covers vision services with no copay and no coinsurance for routine eye exams and covered eyewear, up to annual maximums of $75 and $150 respectively. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Choice H8145-091 (PFFS), offering an annual maximum benefit of $2,000 with no copay and no coinsurance for most preventive, diagnostic, endodontic, and oral surgery services. Medicare-covered dental requires a $35 copay (no coinsurance), restorative and fixed prosthodontics require no copay and 30% to 40% coinsurance, while fluoride, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Choice H8145-091 (PFFS) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy, radiation, and other Part B drugs require no coinsurance to 20% coinsurance. Covered Medicare Part B insulin is subject to a $35 copay and no coinsurance to 20% coinsurance, with step therapy requirements applying to certain drugs.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Choice H8145-091 (PFFS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Humana Gold Choice H8145-091 (PFFS) covers durable medical equipment and prosthetics with a 20% coinsurance and no copay. Diabetic supplies from specified manufacturers are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Choice H8145-091 (PFFS), with coinsurance starting at 25% for diagnostic services and 20% for radiological services. There is no copay for lab services, outpatient X-rays, and diagnostic radiology, while therapeutic radiology has a minimum $35 copay and diagnostic tests have a copay ranging from $0 to $50.
Home Health Services See details
Humana Gold Choice H8145-091 (PFFS) covers Home Health Services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Humana Gold Choice H8145-091 (PFFS) covers cardiac rehabilitation services with no coinsurance, but in practice, only some services are covered. Sub-services such as intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD are not covered under the plan and carry a $15 copay.
Skilled Nursing Facility (SNF) See details
Humana Gold Choice H8145-091 (PFFS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. While a prior three-day hospital stay is not required for admission, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Choice H8145-091 (PFFS) partially covers other services, offering acupuncture for up to 20 treatments per year with a $35 copay and no coinsurance. Over-the-counter items and meal benefits for chronic illnesses are also covered with no copay and no coinsurance, while certain other miscellaneous services are not covered.
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