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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 2025, 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 4 out of 5 stars in 2025.
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 provides comprehensive coverage, including no copays for inpatient hospital stays, primary care visits, and many preventive services such as an annual physical exam. This plan also offers coverage for outpatient services, emergency services, vision and hearing services, and dental services, with varying copays depending on the specific service. Prescription hearing aids have a copay between $699 and $999, and the plan also has a copay for skilled nursing facilities, diagnostic procedures/tests, and more.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the Humana Gold Choice H8145-163 (PFFS) plan. There is no copay for a Medicare-covered stay. Additional Days for Inpatient Hospital-Acute are covered with no copay. However, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $390, observation services with no copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $40 and $95 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Choice H8145-163 (PFFS) plan with a copay of $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Choice H8145-163 (PFFS) plan, with no coinsurance. Ground and Air Ambulance Services have a $315 copay, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by Humana Gold Choice H8145-163 (PFFS). Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay. Urgently Needed Services has no copay.
Primary Care See details
The Humana Gold Choice H8145-163 (PFFS) plan covers primary care physician services and physician specialist services with no copay. Chiropractic services have a $15 copay, while occupational therapy services have a copay between $20 and $40. Mental health and psychiatric services have a $40 copay for individual and group sessions. Physical therapy and speech-language pathology services have a copay between $20 and $40, and additional telehealth benefits range from no copay to a $40 copay. Opioid treatment program services have a copay between $40 and $95.
Preventive Services See details
The Humana Gold Choice H8145-163 (PFFS) plan covers preventive services, including an annual physical exam with no copay. Other preventive services, such as wigs for hair loss related to chemotherapy, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, are covered with no copay. However, Medicare-covered zero-dollar preventive services, health education, in-home safety assessment, personal emergency response system, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, 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, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Humana Gold Choice H8145-163 (PFFS) covers hearing exams with no copay, and also covers routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999.
Vision Services See details
The Humana Gold Choice H8145-163 (PFFS) plan covers vision services, including eye exams with no copay, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventative dental services, and adjunctive general services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Gold Choice H8145-163 (PFFS) plan, including coverage for Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, and also Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Choice H8145-163 (PFFS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered under the Humana Gold Choice H8145-163 (PFFS) plan. Durable Medical Equipment (DME) has a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and no copay, and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 10% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Choice H8145-163 (PFFS). Diagnostic Procedures/Tests have a maximum copay of $105, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $300, and Therapeutic Radiological Services have a maximum copay of $45 and a coinsurance of at most 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-163 (PFFS) plan with no copay and no coinsurance. However, 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 H8145-163 (PFFS) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Choice H8145-163 (PFFS) plan. You will pay a copay of $20 for days 1-20, and a copay of $214 for days 21-100.
Other Services See details
The Humana Gold Choice H8145-163 (PFFS) plan covers acupuncture with no copay, and covers a meal benefit with no copay, but does not cover over-the-counter (OTC) items or Dual Eligible SNPs with Highly Integrated Services. Acupuncture treatments are limited to 20 per year.
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