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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 $31.00. 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 $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:
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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. For example, in the initial coverage phase, you can expect to pay a $15 copay for preferred generic drugs at a standard pharmacy, or 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Choice H8145-164 (PFFS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, but some days are covered with no copay. Outpatient services have copays, while ambulance services have copays and no coinsurance. Primary care and specialist visits have copays, and preventive services like annual exams have no copay. Hearing, vision, and dental services are covered, with copays for some services and no copays for others. The plan also covers home infusion, dialysis, and medical equipment with coinsurance. Emergency services have copays. Other benefits include a meal benefit, OTC items, and acupuncture, each with specific cost structures.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $410 copay for days 1-5, and no copay for days 6-90, and for Additional Days for Inpatient Hospital-Acute, you will pay no copay for days 91-999. Inpatient Hospital Psychiatric services have a $410 copay for days 1-5 and no copay for days 6-90, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $410, and observation services with a $410 copay. Ambulatory Surgical Center (ASC) Services and outpatient blood services have no copay, while outpatient substance abuse services have a $20 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Choice H8145-164 (PFFS) plan, with a $20 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Choice H8145-164 (PFFS) plan, with no coinsurance for any services. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $1250 copay. 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 H8145-164 (PFFS) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, while Urgently Needed Services has a $40 copay; there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Choice H8145-164 (PFFS) plan covers primary care physician services and chiropractic services with a $15 copay. Occupational therapy services have a $30 copay, while physician specialist services have a $50 copay. Mental health specialty services, individual and group psychiatric sessions, and opioid treatment program services have a copay of $20. Physical therapy and speech-language pathology services have a $30 copay. Additional telehealth benefits have a copay that ranges from $0 to $50. Routine chiropractic care is not covered.
Preventive Services See details
The Humana Gold Choice H8145-164 (PFFS) plan covers annual physical exams with no copay, while additional preventive services have varying copays. Other covered preventive services include kidney disease education, glaucoma screenings, 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, and other services are not covered.
Hearing Services See details
Hearing services, including hearing exams, are covered. Hearing exams have a $50 copay, and routine hearing exams are covered for one visit every year with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types, but not for inner, outer, or over-the-ear aids. OTC hearing aids are also covered, with a maximum benefit of $25 every three months.
Vision Services See details
Vision services include eye exams with a copay of $0-$50, routine eye exams with no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Choice H8145-164 (PFFS) plan covers Medicare dental services with a $50 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental 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, 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 by the Humana Gold Choice H8145-164 (PFFS) plan. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered under the Humana Gold Choice H8145-164 (PFFS) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have a 10-20% coinsurance with no copay, and 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, with a copay for diagnostic procedures and tests that ranges from $0 to $100, and no copay for lab services. Outpatient X-ray services have a $15 copay, diagnostic radiological services have a copay of up to $350, and therapeutic radiological services have a copay of up to $50 and coinsurance of up to 20%.
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, but 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. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Choice H8145-164 (PFFS), with a $10 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a $50 copay per visit, with a limit of 20 treatments per year. The plan provides OTC items with a maximum benefit coverage amount of $25 every three months, and also offers a meal benefit with no copay.
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