2022 Humana Gold Choice H8145-125 (PFFS)

Humana Gold Choice H8145-125 (PFFS) H8145-125 is a 2022 Medicare Advantage Plan or Part-C by Humana available to residents in Missouri. This plan includes additional prescription drug (Part-D) coverage. The Humana Gold Choice H8145-125 (PFFS) has a monthly premium of $54.00 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 H8145-125 (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 H8145-125 (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 H8145-125 (PFFS) Part-C Premium

Humana charges a $3.70 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.

H8145-125 Part-D Deductible and Premium

Humana Gold Choice H8145-125 (PFFS) has a monthly drug premium of $50.30 and a $195.00 drug deductible. This Humana plan offers a $50.30 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 $50.30 . 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.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Humana Gold Choice H8145-125 (PFFS) medicare insurance offers a $16.90 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $25.20 for 75% low income subsidy $33.60 for 50% and $41.90 for 25%.

H8145-125 Formulary or Drug Coverage

Humana Gold Choice H8145-125 (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 H8145-125 (PFFS) H8145-125 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$8	$10
Tier 2	$15	$20
Tier 3	$47	$47
Tier 4	$99	$100
Tier 5	29%	29%

*Initial Coverage Phase and 30 day supply

2021 Humana Gold Choice H8145-125 (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	70% coinsurance
Endodontics	55-75% coinsurance (Out-of-Network)
Extractions	50% coinsurance
Extractions	55-75% coinsurance (Out-of-Network)
Non-routine services	55-75% coinsurance (Out-of-Network)
Non-routine services	50% coinsurance
Periodontics	55-75% coinsurance (Out-of-Network)
Periodontics	70% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services	55-75% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	70% coinsurance
Restorative services	50-70% coinsurance
Restorative services	55-75% coinsurance (Out-of-Network)

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	30% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$40-250 copay or 20-25% coinsurance
Diagnostic tests and procedures	$0-40 copay or 25% coinsurance
Diagnostic tests and procedures	$0 copay or 30% coinsurance (Out-of-Network)
Lab services	$0-30 copay or 25% coinsurance
Lab services	30% coinsurance (Out-of-Network)
Outpatient x-rays	30% coinsurance (Out-of-Network)
Outpatient x-rays	$10-40 copay or 25% coinsurance

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Doctor Visits

Primary	30% coinsurance per visit (Out-of-Network)
Primary	$10 copay per visit
Specialist	30% coinsurance per visit (Out-of-Network)
Specialist	$40 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$10-40 copay or 30% coinsurance per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	30% coinsurance (Out-of-Network)
Foot exams and treatment	$40 copay
Routine foot care	Not covered

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Ground Ambulance

$265 copay (Out-of-Network)
$265 copay

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Hearing

Fitting/evaluation	$0 copay (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$399-699 copay
Hearing aids	$399-699 copay (Out-of-Network)
Hearing exam	30% coinsurance (Out-of-Network)
Hearing exam	$40 copay

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Inpatient Hospital Coverage

$295 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond
30% per stay (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	30% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay or 10-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	25% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	15% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	30% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	30% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$295 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay

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MOOP

$6,700 In and Out-of-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$40 copay or 25% coinsurance per visit
30% coinsurance per visit (Out-of-Network)

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Preventive Care

$0 copay or 30% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

Cleaning	$0 copay
Cleaning	50% coinsurance (Out-of-Network)
Dental x-ray(s)	50% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	50% coinsurance (Out-of-Network)
Fluoride treatment	$0 copay
Oral exam	50% coinsurance (Out-of-Network)
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	$35-40 copay
Occupational therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$35-40 copay

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Skilled Nursing Facility

$0 per day for days 1 through 20 $178 per day for days 21 through 100
30% per stay (Out-of-Network)

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Transportation

Not covered

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Vision

Contact lenses	$0 copay (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	$0 copay (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Humana Gold Choice H8145-125 (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 H8145-125 (PFFS) Plans Performance

Health Plan Customer Service Rating for Humana Gold Choice H8145-125 (PFFS)

Humana Gold Choice H8145-125 (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 H8145-125 (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.