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Humana Gold Choice H8145-163 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-163 (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 H8145-163 (PFFS) in 2026, please refer to our full plan details page.
Humana Gold Choice H8145-163 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Choice H8145-163 (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 H8145-163 (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 H8145-163 (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 $1500.00 (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 $1500.00 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 H8145-163 (PFFS)
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Drug Coverage
Prescription drugs are not covered by Humana Gold Choice H8145-163 (PFFS).
Additional Benefits
The Humana Gold Choice H8145-163 (PFFS) plan offers robust coverage with no copays or coinsurance for inpatient hospital stays, primary care, and specialist visits. Outpatient hospital services feature copays ranging up to $415, while urgent care has no copay and emergency services require a $150 copay. Additionally, routine home health care is fully covered with no out-of-pocket costs. Routine dental, vision, and hearing exams are highly accessible with no copays or coinsurance, though prescription hearing aids require copays between $699 and $999. Skilled nursing facility care is available with daily copays of $20 for the first 20 days and $218 for days 21 through 100. Durable medical equipment and dialysis services generally require a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Humana Gold Choice H8145-163 (PFFS) with no copay and no coinsurance for Medicare-covered acute and psychiatric stays. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under Humana Gold Choice H8145-163 (PFFS) are covered with no coinsurance, featuring a $0 to $415 copay for outpatient hospital services and no copay for ambulatory surgical center, observation, and blood services. Outpatient substance abuse individual and group sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Choice H8145-163 (PFFS) covers partial hospitalization services with a $35.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Humana Gold Choice H8145-163 (PFFS) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance per trip. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Humana Gold Choice H8145-163 (PFFS) covers emergency services with a $150 copay and no coinsurance, while urgently needed services are covered with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered under the plan with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Choice H8145-163 (PFFS) covers primary care and specialist visits with no copay and no coinsurance, while physical, occupational, and speech therapies require a $20 to $40 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $35 copay and no coinsurance, but podiatry is not covered, and only some chiropractic services are covered with a $20 copay and no coinsurance, excluding routine and other chiropractic care.
Preventive Services See details
Humana Gold Choice H8145-163 (PFFS) preventive services are partially covered with no copay and no coinsurance for annual physicals, kidney education, select screenings, fitness benefits, and wigs for hair loss up to $500 annually. Medicare-covered zero dollar preventive services are not covered under this plan. Excluded sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by Humana Gold Choice H8145-163 (PFFS), offering routine exams and hearing aid evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay ranging from $699 to $999 and no coinsurance, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Choice H8145-163 (PFFS) with no copay, no coinsurance, and no deductible for covered services. The plan covers one routine eye exam (up to $75) and eyeglasses (lenses and frames) or contact lenses (up to $200) yearly, but other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Choice H8145-163 (PFFS) provides partially covered dental services with no copay and no coinsurance for covered treatments such as exams, cleanings, x-rays, and oral surgery. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Choice H8145-163 (PFFS) covers Home Infusion bundled Services with no copay, though associated Medicare Part B chemotherapy, radiation, and other drugs require a coinsurance of no coinsurance to 20%. Covered Part B insulin drugs require a $35 copay and a coinsurance of no coinsurance to 20%, with step therapy rules applying to some treatments.
Dialysis Services See details
Dialysis services are covered by Humana Gold Choice H8145-163 (PFFS) with no copay and a 20% coinsurance.
Medical Equipment See details
Humana Gold Choice H8145-163 (PFFS) covers durable medical equipment, prosthetic devices, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Choice H8145-163 (PFFS) covers diagnostic and radiological services, offering lab services, diagnostic radiological services, and outpatient X-rays with no copay. Diagnostic procedures and tests carry a copay of $0 to $105 with no coinsurance, while therapeutic radiological services require a minimum $45 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Gold Choice H8145-163 (PFFS) with no copay and no coinsurance. This ensures eligible members can receive necessary in-home care at no out-of-pocket cost.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Choice H8145-163 (PFFS) with no coinsurance and copayments ranging from no copay to $15. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Choice H8145-163 (PFFS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. A prior three-day inpatient hospital stay is not required for admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Choice H8145-163 (PFFS) partially covers other services with no copay and no coinsurance, including up to 20 acupuncture treatments per year and meal benefits for chronic illnesses. Over-the-counter (OTC) items are not covered.
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