A non-government entity
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 2025, 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 4 out of 5 stars in 2025.
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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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 coverage for a wide range of services. The plan includes coverage for inpatient hospital stays with a $360 copay, outpatient services with copays between $30 and $360, and emergency services with a $90 copay. This plan also offers benefits for primary care with a $5 copay, hearing exams with a $40 copay, and dental services with no copay for many services. Other benefits include coverage for home health services with no copay, and skilled nursing facility services with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $360 copay for days 1-5, and no copay for days 6-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $360 copay for days 1-4, and no copay for days 5-90, with no coinsurance. Additional Days for Inpatient Hospital-Acute has no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, for the Humana Gold Choice H8145-126 (PFFS) plan, includes coverage for outpatient hospital services with a copay between $45 and $360, and observation services with a $360 copay. Ambulatory Surgical Center (ASC) services have a $225 copay, and outpatient substance abuse services have copays between $30 and $50 for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Choice H8145-126 (PFFS) plan, with a copay of $45.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Choice H8145-126 (PFFS) plan. Ground ambulance services have a copay of $265, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Choice H8145-126 (PFFS) plan. Emergency Services have a $90 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay.
Primary Care See details
Primary Care Physician Services have a $5 copay, Chiropractic Services have a $15 copay, and Routine Chiropractic Care is not covered. Occupational Therapy Services have a $25 copay, while Physician Specialist Services have a $40 copay. Individual and Group Sessions for Mental Health Specialty Services have a $30 copay, and Podiatry Services are not covered. Other Health Care Professional services have a copay between $5 and $40, and Individual and Group Sessions for Psychiatric Services have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a $25 copay, Additional Telehealth Benefits have a copay between $0 and $55, and Opioid Treatment Program Services have a copay between $30 and $50.
Preventive Services See details
The Humana Gold Choice H8145-126 (PFFS) plan covers preventive services, including an annual physical exam with no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. However, Medicare-covered Zero Dollar Preventive Services, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with the plan covering prescription hearing aids (all types) with a copay between $699 and $999. OTC hearing aids are covered with a maximum benefit of $75 every three months.
Vision Services See details
Vision services include eye exams with a copay of $0-$40. Routine eye exams have no copay for one visit per year, and eyewear is covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Choice H8145-126 (PFFS) plan covers dental services, including Medicare and other dental services, with a $3,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services includes coverage for Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Step therapy is required, and the benefit steps from Part B to Part D.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Choice H8145-126 (PFFS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Choice H8145-126 (PFFS) plan. Diagnostic Procedures/Tests have a copay between $0 and $55, and Lab Services have no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20% and a copay of at most $250 and $40 respectively, while Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-126 (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 H8145-126 (PFFS) plan. Some services may have a copay, but the plan does not specify the amount.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Choice H8145-126 (PFFS) plan. There is no copay for days 1-20, and a $172 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $40 copay, and is limited to 20 treatments per year. The plan provides OTC items with a maximum benefit of $75 every three months, and a meal benefit with no copay. Dual Eligible SNPs with Highly Integrated Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved