Humana Gold Choice H8145-004 (PFFS) H8145-004 is a 2023 Medicare Advantage Plan or Part-C by Humana available to residents in Virginia and North Carolina. This plan includes extra prescription drug (Part-D) coverage. Humana Humana Gold Choice H8145-004 (PFFS) has a monthly premium of $68.00 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 H8145-004 (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 Virginia or Medicare Advantage in North Carolina.

2023 Humana Medicare Advantage Plan Overview

What type of plan is Humana Gold Choice H8145-004 (PFFS)

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.

How much does Humana Gold Choice H8145-004 (PFFS) cost?

Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Humana charges a $68.00 consolidated premium. The Part C premium is $68.00 this charge covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. Humana Gold Choice H8145-004 (PFFS) has a monthly drug premium of $0 and a $160.00 drug deductible. This Humana plan offers a $0 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. This Premium covers any enhanced plan benefits offered by Humana above and beyond the standard PDP benefits. This can include extra coverage in the gap, lower co-payments, and coverage of non-Part D drugs. The Part D Total Premium is $0. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Humana Gap Coverage

In 2023 once you and your plan provider have spent $4660 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 extra coverage. This Humana plan does not offer extra coverage through the gap.

Formulary and 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.

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

The complete Humana Gold Choice H8145-004 (PFFS) Formulary.
*Initial Coverage Phase and 30 day supply

2023 Summary of Benefits

The benefit information provided is a summary of what Humana Gold Choice H8145-004 (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)	Covered

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Contact lenses

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

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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)

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

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Other

Vision	Not covered

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Routine eye exam

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

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Upgrades

Vision	Not covered

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Out-of-Network Transportation	$50 copay
In-Network Transportation	$0 copay
Out-of-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $184 per day for days 21 through 62 $0 per day for days 63 through 100
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $184 per day for days 21 through 62 $0 per day for days 63 through 100

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Occupational therapy visit

In-Network Rehabilitation services	$15-40 copay
Out-of-Network Rehabilitation services	$15-40 copay

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Physical therapy and speech and language therapy visit

Out-of-Network Rehabilitation services	$15-40 copay
In-Network Rehabilitation services	$15-40 copay

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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)

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

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Fluoride treatment

In-Network Preventive dental	$0 copay
Out-of-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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Out-of-Network Preventive care	$0 copay
In-Network Preventive care	$0 copay
Out-of-Network Outpatient hospital coverage	$50-345 copay per visit
In-Network Outpatient hospital coverage	$50-345 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

Out-of-Network Mental health services	$345 per day for days 1 through 4 $0 per day for days 5 through 90
In-Network Mental health services	$345 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	$40 copay
Out-of-Network Mental health services	$40-100 copay

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Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$40 copay
Out-of-Network Mental health services	$40-100 copay

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Outpatient individual therapy visit

In-Network Mental health services	$40 copay
Out-of-Network Mental health services	$40-100 copay

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Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$40 copay
Out-of-Network Mental health services	$40-100 copay

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Chemotherapy

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

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Diabetes supplies

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

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

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-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)	$7,550 In and Out-of-network
In-Network Inpatient hospital coverage	$345 per day for days 1 through 5 $0 per day for days 6 through 90 $0 per day for days 91 and beyond
Out-of-Network Inpatient hospital coverage	$345 per day for days 1 through 5 $0 per day for days 6 through 90

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Fitting/evaluation

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

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Hearing aids

In-Network Hearing	$99-399 copay
Out-of-Network Hearing	$99.99-399.99 copay

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Hearing exam

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

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Health plan deductible	$750 Out-of-network
Out-of-Network Ground ambulance	$290 copay
In-Network Ground ambulance	$290 copay

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Foot exams and treatment

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

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	$95 copay per visit (always covered)

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Urgent care

Emergency care/Urgent care	$40 copay per visit (always covered)

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Primary

Out-of-Network Doctor visits	$0 copay
In-Network Doctor visits	$0 copay

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Specialist

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

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Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$50-275 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$50-345 copay

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Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$0-100 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$0-110 copay

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Lab services

Out-of-Network Diagnostic procedures/lab services/imaging	$0-110 copay
In-Network Diagnostic procedures/lab services/imaging	$0-50 copay

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Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	$0-110 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$0-110 copay

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Diagnostic services

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

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

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

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Restorative services

Out-of-Network Comprehensive dental	$0 copay
In-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 H8145-004 (PFFS) Reviews

Is Humana Gold Choice H8145-004 (PFFS) a good plan? Humana Gold Choice H8145-004 (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 004 Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H8145-004 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 H8145-004 (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.