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Humana Gold Choice H8145-164 (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Choice H8145-164 (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 H8145-164 (PFFS) in 2025, please refer to our full plan details page.
Humana Gold Choice H8145-164 (PFFS) is a PFFS plan offered by Humana Inc. available for enrollment in 2025 to people living in CO, NM. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Humana Gold Choice H8145-164 (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 H8145-164 (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 H8145-164 (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 $300.00 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 $5200.00 (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 $5200.00 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 H8145-164 (PFFS) plan has a $300 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. In the initial coverage phase, you will pay a copay for generic drugs, and coinsurance for brand name and non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Choice H8145-164 (PFFS) plan offers a range of benefits, including inpatient hospital stays with a copay, and outpatient services with varying copays. The plan also covers primary care, specialist visits, and mental health services with copays. Additional benefits include preventive services with no copay for some services, and hearing, vision, and dental coverage. The plan also provides coverage for ambulance services and home health services with specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $325 for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, along with additional days and non-Medicare-covered stays for inpatient hospital psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $325, and observation services with a $325 copay per stay. The plan also covers Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions. Additionally, Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Choice H8145-164 (PFFS) plan. You will pay a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Choice H8145-164 (PFFS) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $1250 copay, and there is no coinsurance for either service; however, Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Humana Gold Choice H8145-164 (PFFS). Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation have a $125 copay, while Urgently Needed Services has a $40 copay.
Primary Care See details
Humana Gold Choice H8145-164 (PFFS) covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, and Occupational Therapy Services with a $30 copay. The plan also covers Physician Specialist Services with a $50 copay, Mental Health Specialty Services with a copay of $20, and Podiatry Services with a $50 copay. Other Health Care Professional services have a copay between $0 and $50, while Psychiatric Services have a $20 copay. Physical Therapy and Speech-Language Pathology Services have a $30 copay, Additional Telehealth Benefits have a copay between $0 and $50, and Opioid Treatment Program Services have a $20 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services with a copay, as well as other services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, all with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
For Humana Gold Choice H8145-164 (PFFS), hearing exams have a $50 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $699 and $999, while OTC hearing aids are covered up to $75 every three months. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Humana Gold Choice H8145-164 (PFFS) plan covers vision services including eye exams with a copay between $0 and $50, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,000 maximum benefit per year. Medicare Dental Services have a $50 copay, while Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery have no copay. Prosthodontics, fixed has a 30% coinsurance and no copay, while Fluoride Treatment, Prosthodontics, removable, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Choice H8145-164 (PFFS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetic devices, and medical supplies, is covered under this plan. Durable Medical Equipment (DME) has a 20% coinsurance, and the plan does not cover DME for use outside the home. Prosthetic devices have a 20% coinsurance, and medical supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Humana Gold Choice H8145-164 (PFFS) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $100, and Lab Services have no copay; Diagnostic Radiological Services have a copay up to $275, while Therapeutic Radiological Services have a coinsurance up to 20% and a copay up to $50, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Choice H8145-164 (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 H8145-164 (PFFS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Choice H8145-164 (PFFS) with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Choice H8145-164 (PFFS) plan covers acupuncture with a $50 copay, over-the-counter (OTC) items with a maximum benefit of $75 every three months, and meal benefits with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services.
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