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Humana Gold Choice H8145-126 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-126 (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 H8145-126 (PFFS) in 2026, please refer to our full plan details page.
Humana Gold Choice H8145-126 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in AR, IL, KS, MO, OK, TX. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Choice H8145-126 (PFFS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Choice H8145-126 (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 H8145-126 (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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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:
Sign up for Humana Gold Choice H8145-126 (PFFS)
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Drug Coverage
Prescription drugs are not covered by Humana Gold Choice H8145-126 (PFFS).
Additional Benefits
The Humana Gold Choice H8145-126 PFFS plan provides comprehensive medical coverage with no copay or coinsurance for primary care visits and annual preventive exams. Specialist visits require a $40 copay, while emergency room services are covered with a $90 copay. For inpatient hospital stays, members pay a $360 daily copay for the first few days of care and no copay for the remainder of their stay. Additionally, the plan features strong supplemental benefits including dental and vision care with no copay for most routine services up to annual limits. Routine hearing exams and home health services also require no copay, though prescription hearing aids carry a copay between $699 and $999. Skilled nursing facility care is covered with no copay for the first 20 days of your stay.
Inpatient Hospital See details
Humana Gold Choice H8145-126 (PFFS) partially covers inpatient hospital benefits with no coinsurance, featuring a $360 daily copay for days 1 through 5 of acute stays (no copay for days 6 through 999) and days 1 through 4 of psychiatric stays (no copay for days 5 through 90). Upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Choice H8145-126 (PFFS) with no coinsurance for all services. Copays range from no copay for ambulatory surgical center and blood services, $30 to $35 for outpatient substance abuse sessions, and up to $360 for outpatient hospital and observation services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Gold Choice H8145-126 (PFFS) with a $35.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Humana Gold Choice H8145-126 (PFFS) partially covers ambulance and transportation services, as transportation services to health-related locations are not covered. Covered ground ambulance services require a $250 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
Humana Gold Choice H8145-126 (PFFS) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered, each requiring a $90 copay and no coinsurance.
Primary Care See details
Humana Gold Choice H8145-126 (PFFS) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Additional benefits like telehealth, therapy, and mental health services are covered with copays ranging from $0 to $50 and no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Humana Gold Choice H8145-126 (PFFS) plan are partially covered, offering annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. However, Medicare-covered zero-dollar preventive services and various additional benefits—including fitness, health education, weight management, and in-home support—are not covered.
Hearing Services See details
Humana Gold Choice H8145-126 (PFFS) covers hearing exams with a $40 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids are covered with no copay or coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance, but inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Gold Choice H8145-126 (PFFS) offers partially covered vision services with no deductibles or coinsurance, including annual routine eye exams with no copay and other eye exams with copays up to $40. Covered eyewear features no copay or coinsurance up to a combined $300 annual limit for contact lenses and complete eyeglasses, though separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Choice H8145-126 (PFFS) offers partially covered dental services with a $40 copay and no coinsurance for Medicare-covered dental care. Most other preventive and comprehensive services have no copay and no coinsurance up to a $3,500 annual limit, though fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Humana Gold Choice H8145-126 (PFFS) covers home infusion bundled services, including chemotherapy, radiation, and other Part B drugs with no copay and 0% to 20% coinsurance. Covered Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Choice H8145-126 (PFFS) plan with a 20% coinsurance and no copay.
Medical Equipment See details
Humana Gold Choice H8145-126 (PFFS) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services. DME, prosthetics, and medical supplies require a 20% coinsurance and no copay, while diabetic supplies carry a 10% to 20% coinsurance with no copay, and diabetic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Choice H8145-126 (PFFS), featuring no copay or coinsurance for lab and outpatient X-ray services. Diagnostic procedures and tests require no coinsurance and a $0 to $50 copay, while diagnostic and therapeutic radiological services require 20% coinsurance alongside copays of up to $200 and $40, respectively.
Home Health Services See details
Home Health Services are covered by Humana Gold Choice H8145-126 (PFFS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by Humana Gold Choice H8145-126 (PFFS). This includes cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services, which are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Humana Gold Choice H8145-126 (PFFS) partially covers Skilled Nursing Facility (SNF) services, offering no copay and no coinsurance for days 1 through 20, followed by a $150 copay and no coinsurance for days 21 through 100. Additional days beyond standard Medicare coverage are not covered.
Other Services See details
Humana Gold Choice H8145-126 (PFFS) covers acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, along with over-the-counter items and meal benefits with no copay and no coinsurance. Dual Eligible SNPs with Highly Integrated Services are not covered under this other services benefit.
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