Humana Gold Choice H8145-126 (PFFS) H8145-126 is a 2023 Medicare Advantage Plan or Part-C by Humana available to residents in Texas. This plan does not provide extra prescription drug (Part-D) coverage. Humana Humana Gold Choice H8145-126 (PFFS) has a monthly premium of $30.00 and has an in-network maximum out-of-pocket limit of $- (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $- out-of-pocket. This can be an extremely nice safety net.

Humana works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Humana Gold Choice H8145-126 (PFFS) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Humana except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Texas.

2023 Humana Medicare Advantage Plan Overview

What type of plan is Humana Gold Choice H8145-126 (PFFS)

Humana Gold Choice H8145-126 (PFFS) is a PFFS *. A Private Fee-For-Service (PFFS) plan is a Medicare Advantage (MA) health plan offered by a contract with the Centers for Medicare & Medicaid Services (CMS) to provide you with benefits. Humana (instead of Medicare) will decide on how much it will cover and how much you will pay for the services you get. You may go to any Medicare approved doctor or hospital or any other health care provider that accepts both Medicare and your plans payment. A PFFS plan has no provider network, and you dont need a referral or a primary care physician for any health care or services. PFFS plans are the most flexible but a doctor will make a visit-by-visit decisions on whether to accept your provider.

How much does Humana Gold Choice H8145-126 (PFFS) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Humana charges a $30.00 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

2023 Summary of Benefits

The benefit information provided is a summary of what Humana Gold Choice H8145-126 (PFFS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Humana helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Not covered

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Contact lenses

Vision	Not covered

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Eyeglass frames

Vision	Not covered

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Eyeglass lenses

Vision	Not covered

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Eyeglasses (frames and lenses)

Vision	Not covered

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Other

Vision	Not covered

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Routine eye exam

Out-of-Network Vision	$0 copay
In-Network Vision	$0 copay

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Upgrades

Vision	Not covered

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Transportation	Not covered
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $172 per day for days 21 through 100
Out-of-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $172 per day for days 21 through 100

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Occupational therapy visit

Out-of-Network Rehabilitation services	$50 copay or 30% coinsurance
In-Network Rehabilitation services	$25 copay

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Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$25 copay
Out-of-Network Rehabilitation services	$50 copay or 30% coinsurance

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Cleaning

Out-of-Network Preventive dental	$0 copay
In-Network Preventive dental	$0 copay

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Dental x-ray(s)

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	$0 copay

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Fluoride treatment

Out-of-Network Preventive dental	$0 copay
In-Network Preventive dental	$0 copay

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Oral exam

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	$0 copay

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In-Network Preventive care	$0 copay
Out-of-Network Preventive care	$0 copay or 30% coinsurance
In-Network Outpatient hospital coverage	$45-360 copay per visit
Out-of-Network Outpatient hospital coverage	$50 copay or 30% coinsurance per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	Yes

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Inpatient hospital - psychiatric

Out-of-Network Mental health services	$360 per day for days 1 through 4 $0 per day for days 5 through 90
In-Network Mental health services	$360 per day for days 1 through 4 $0 per day for days 5 through 90

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Outpatient group therapy visit

In-Network Mental health services	$30 copay
Out-of-Network Mental health services	$50 copay

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Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$30 copay
Out-of-Network Mental health services	$50 copay

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Outpatient individual therapy visit

Out-of-Network Mental health services	$50 copay
In-Network Mental health services	$30 copay

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Outpatient individual therapy visit with a psychiatrist

Out-of-Network Mental health services	$50 copay
In-Network Mental health services	$30 copay

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Chemotherapy

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	20-30% coinsurance

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Other Part B drugs

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	20-30% coinsurance

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Diabetes supplies

Out-of-Network Medical equipment/supplies	20% coinsurance per item
In-Network Medical equipment/supplies	$0 copay or 10-20% coinsurance per item

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Durable medical equipment (e.g., wheelchairs, oxygen)

Out-of-Network Medical equipment/supplies	20% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

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Prosthetics (e.g., braces, artificial limbs)

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	20% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$6,700 In and Out-of-network
Out-of-Network Inpatient hospital coverage	$360 per day for days 1 through 5 $0 per day for days 6 through 90
In-Network Inpatient hospital coverage	$360 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond

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Fitting/evaluation

In-Network Hearing	$0 copay
Out-of-Network Hearing	$0 copay

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Hearing aids

Out-of-Network Hearing	$699-999 copay
In-Network Hearing	$699-999 copay

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Hearing exam

In-Network Hearing	$40 copay
Out-of-Network Hearing	$50 copay

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Health plan deductible	$0
Out-of-Network Ground ambulance	$265 copay
In-Network Ground ambulance	$265 copay

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Foot exams and treatment

Out-of-Network Foot care (podiatry services)	$50 copay
In-Network Foot care (podiatry services)	$40 copay

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	$90 copay per visit (always covered)

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Urgent care

Emergency care/Urgent care	$35 copay per visit (always covered)

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Primary

In-Network Doctor visits	$5 copay per visit
Out-of-Network Doctor visits	$20 copay per visit

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Specialist

Out-of-Network Doctor visits	$50 copay per visit
In-Network Doctor visits	$40 copay per visit

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Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$40-250 copay or 20% coinsurance
Out-of-Network Diagnostic procedures/lab services/imaging	$50 copay or 30% coinsurance

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Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$0-50 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$20-50 copay or 30% coinsurance

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Lab services

In-Network Diagnostic procedures/lab services/imaging	$0-50 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$20-50 copay or 30% coinsurance

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Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	$5-50 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$20-50 copay or 30% coinsurance

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Diagnostic services

Out-of-Network Comprehensive dental	$0 copay
In-Network Comprehensive dental	$0 copay

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Endodontics

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Extractions

Out-of-Network Comprehensive dental	$0 copay
In-Network Comprehensive dental	$0 copay

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Non-routine services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Periodontics

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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Prosthodontics, other oral/maxillofacial surgery, other services

Out-of-Network Comprehensive dental	$0 copay
In-Network Comprehensive dental	$0 copay

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Restorative services

In-Network Comprehensive dental	$0 copay
Out-of-Network Comprehensive dental	$0 copay

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	Yes, contact plan for further details

Humana Gold Choice H8145-126 (PFFS) Reviews

Is Humana Gold Choice H8145-126 (PFFS) a good plan? Humana Gold Choice H8145-126 (PFFS) received a 4 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare Humana Gold Choice H8145 126 Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H8145-126 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Humana

Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for Humana Gold Choice H8145-126 (PFFS) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.