2022 Humana Gold Choice H8145-004 (PFFS)

Humana Gold Choice H8145-004 (PFFS) H8145-004 is a 2022 Medicare Advantage Plan or Part-C by Humana available to residents in Virginia and North Carolina. This plan includes additional prescription drug (Part-D) coverage. The Humana Gold Choice H8145-004 (PFFS) has a monthly premium of $87.00 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 a extremely nice safety net.

Humana Gold Choice H8145-004 (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.

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 H8145-004 (PFFS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Humana and not Original Medicare. With Medicare Advantage 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 even if you sign up for Medicare Advantage.

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2022 Humana Medicare Advantage Plan Costs

Humana Gold Choice H8145-004 (PFFS) Part-C Premium

Humana charges a $87.00 Part-C 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.

H8145-004 Part-D Deductible and Premium

Humana Gold Choice H8145-004 (PFFS) has a monthly drug premium of $0.00 and a $160.00 drug deductible. This Humana plan offers a $0.00 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Humana above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Humana Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Humana plan does not offer additional coverage through the gap.

H8145-004 Formulary or Drug Coverage

Humana Gold Choice H8145-004 (PFFS) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 Humana Gold Choice H8145-004 (PFFS) H8145-004 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$5	$10
Tier 2	$15	$20
Tier 3	$47	$47
Tier 4	$99	$100
Tier 5	30%	30%

*Initial Coverage Phase and 30 day supply

2021 Humana Gold Choice H8145-004 (PFFS) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	$0 copay (Out-of-Network)
Endodontics	$0 copay
Extractions	$0 copay (Out-of-Network)
Extractions	$0 copay
Non-routine services	$0 copay (Out-of-Network)
Non-routine services	$0 copay
Periodontics	$0 copay
Periodontics	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	$0 copay (Out-of-Network)
Restorative services	$0 copay

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Deductible

$750 Out-of-network

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$50-275 copay
Diagnostic radiology services (e.g., MRI)	$50-345 copay (Out-of-Network)
Diagnostic tests and procedures	$0-100 copay (Out-of-Network)
Diagnostic tests and procedures	$0-100 copay
Lab services	$0-100 copay (Out-of-Network)
Lab services	$0-50 copay
Outpatient x-rays	$20-110 copay (Out-of-Network)
Outpatient x-rays	$20-110 copay

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Doctor Visits

Primary	$20 copay per visit
Primary	$20 copay per visit (Out-of-Network)
Specialist	$50 copay per visit (Out-of-Network)
Specialist	$50 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$20-50 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$50 copay (Out-of-Network)
Foot exams and treatment	$50 copay
Routine foot care	Not covered

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Ground Ambulance

$290 copay
$290 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$99-399 copay (Out-of-Network)
Hearing aids	$99-399 copay
Hearing exam	$50 copay (Out-of-Network)
Hearing exam	$50 copay

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Inpatient Hospital Coverage

$345 per day for days 1 through 5 $0 per day for days 6 through 90 (Out-of-Network)
$345 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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Medical Equipment/Supplies

Diabetes supplies	$10 copay or 10-20% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay or 10-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	20% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance
Other Part B drugs	20% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	$345 per day for days 1 through 4 $0 per day for days 5 through 90
Inpatient hospital - psychiatric	$345 per day for days 1 through 4 $0 per day for days 5 through 90 (Out-of-Network)
Outpatient group therapy visit	$40-100 copay (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit with a psychiatrist	$40-100 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	$40-100 copay (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40-100 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay

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MOOP

$7,550 In and Out-of-network

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Option

No

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Optional supplemental benefits

Yes

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Outpatient Hospital Coverage

$50-345 copay per visit
$50-345 copay per visit (Out-of-Network)

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Package #1

Deductible
Monthly Premium	$15.30

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Preventive Care

$0 copay
$0 copay (Out-of-Network)

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Preventive Dental

Cleaning	$0 copay (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay
Fluoride treatment	$0 copay (Out-of-Network)
Oral exam	$0 copay
Oral exam	$0 copay (Out-of-Network)

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Rehabilitation Services

Occupational therapy visit	$15-40 copay
Occupational therapy visit	$15-40 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$15-40 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$15-40 copay

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Skilled Nursing Facility

$0 per day for days 1 through 20 $184 per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $184 per day for days 21 through 100

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Transportation

$0 copay
50% coinsurance (Out-of-Network)

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Vision

Contact lenses	Not covered
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	Not covered
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Humana Gold Choice H8145-004 (PFFS) H8145

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Humana Gold Choice H8145-004 (PFFS) Plans Performance

Health Plan Customer Service Rating for Humana Gold Choice H8145-004 (PFFS)

Humana Gold Choice H8145-004 (PFFS) 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

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for Humana Gold Choice H8145-004 (PFFS)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.