Humana Gold Choice H8145-163 (PFFS)
Humana Gold Choice H8145-163 (PFFS) H8145-163 Plan Details
Humana Gold Choice H8145-163 (PFFS) is a PFFS Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H8145-163
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$108.00
Monthly Premium
Humana Gold Choice H8145-163 (PFFS) is a PFFS Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H8145-163
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Humana Gold Choice H8145-163 (PFFS) H8145-163 Plan Details
Humana Gold Choice H8145-163 (PFFS) is a PFFS Medicare Advantage (Medicare Part C) plan offered by Humana Inc.
Plan ID: H8145-163
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$108.00
Monthly Premium
Pennsylvania Counties Served
Elk
Somerset
Bedford
Jefferson
Clarion
Clearfield
Cameron
Huntingdon
Blair
Montgomery
Chester
Delaware
Philadelphia
Potter
Erie
Forest
Mckean
Venango
Mercer
Warren
Crawford
Northampton
Lehigh
Carbon
Schuylkill
Monroe
Luzerne
Lackawanna
Susquehanna
Wyoming
Beaver
Fayette
Sullivan
Westmoreland
Allegheny
Washington
Butler
Greene
Armstrong
Fulton
Cumberland
Clinton
York
Lawrence
Juniata
Lycoming
Tioga
Bradford
Mifflin
Dauphin
Perry
Lebanon
Snyder
Adams
Berks
Lancaster
Wayne
Bucks
Montour
Union
Centre
Franklin
Pike
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $-1 |
| Out of Pocket Max |
In-Network: $-1 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 Out-of-Network: Doctor Office Visit Services: Copayment for Medicare Covered Primary Care Office Visit $0 |
| Specialty Doctor Visit | In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $0 Out-of-Network: Doctor Specialty Visit Services: Copayment for Medicare Covered Physician Specialist Office Visit $0 |
| Inpatient Hospital Care | In-Network: Acute Hospital Services: Copayment for Acute Hospital Services per Stay $0 Out-of-Network: Acute Hospital Services: Copayment for Acute Hospital Services per Stay $0 |
| Urgent Care | Copayment for Urgent Care $0 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $140 |
| Emergency Room Visit | Copayment for Emergency Care $140 Worldwide Coverage: Copayment for Worldwide Emergency Coverage $140 Copayment for Worldwide Emergency Transportation $140 |
| Ambulance Transportation | In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $315 Air Ambulance: Copayment for Air Ambulance Services $315 Out-of-Network: Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $315 Copayment for Medicare Covered Ambulance Services - Air $315 |
Health Care Services and Medical Supplies
Humana Gold Choice H8145-163 (PFFS) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Copayment for Medicare-covered Chiropractic Services $15 Out-of-Network: Medicare Covered Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $15 |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: Copayment for Medicare-covered Diabetic Supplies $0 Coinsurance for Medicare-covered Diabetic Supplies 10% Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $10 Out-of-Network: Medicare Covered Diabetic Supplies and Services: Coinsurance for Medicare Covered Diabetic Supplies 10% Copayment for Medicare Covered Diabetic Therapeutic Shoes or Inserts $10 Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 20% |
| Durable Medical Eqipment (DME) | In-Network: Coinsurance for Medicare-covered Durable Medical Equipment 20% Out-of-Network: Medicare Covered Durable Medical Equipment Services: Coinsurance for Medicare Covered Durable Medical Equipment 20% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $105 Copayment for Medicare-covered Lab Services $0 to $20 $105 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$0 OP Diag Proc & Tests - SPC$0 OP Diag Proc & Tests - UCC$105 Sleep Study (Fac Based) - OPH$105 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home_ Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 to $300 Copayment for Medicare-covered Therapeutic Radiological Services $45 Coinsurance for Medicare-covered Therapeutic Radiological Services 20% Copayment for Medicare-covered X-Ray Services $0 to $100 Out-of-Network: Medicare Covered Diagnostic Procedures/Tests Services: Copayment for Medicare Covered Diagnostic Procedures/Tests $0 to $105 Copayment for Medicare Covered Lab Services $0 to $20 Copayment for Medicare Covered Diagnostic Radiological Services $0 to $300 Copayment for Medicare Covered Therapeutic Radiological Services $45 Coinsurance for Medicare Covered Therapeutic Radiological Services 20% Copayment for Medicare Covered Outpatient X-Ray Services $0 to $100 $105 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$0 OP Diag Proc & Tests - SPC$0 OP Diag Proc & Tests - UCC$105 Sleep Study (Fac Based) - OPH$105 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home_ |
| Home Health Care | In-Network: Copayment for Medicare-covered Home Health Services $0 Out-of-Network: Medicare Covered Home Health Services: Copayment for Medicare Covered Home Health $0 |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0 Out-of-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital per Stay $0 |
| Mental Health Outpatient Care | In-Network: Copayment for Medicare-covered Individual Sessions $40 Copayment for Medicare-covered Group Sessions $40 Out-of-Network: Medicare Covered Mental Health Services: Copayment for Medicare Covered Individual Sessions $40 Copayment for Medicare Covered Group Sessions $40 |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $390 $0 Diag Colonoscopy - OPH$95 Mental Health - OPH$390 Surgery Svcs - OPH$45 Wound Care - OPH_ Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $0 Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 to $340 $0 Diag Colonoscopy - ASC$340 Surgery Svcs - ASC_ Out-of-Network: Medicare Covered Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $390 Copayment for Medicare Covered Ambulatory Surgical Center Services $0 to $340 $0 Diag Colonoscopy - OPH$95 Mental Health - OPH$390 Surgery Svcs - OPH$45 Wound Care - OPH_ |
| Outpatient Substance Abuse Care | In-Network: Copayment for Medicare-covered Individual Sessions $40 to $95 Copayment for Medicare-covered Group Sessions $40 to $95 $95 OP Substance Abuse Care - OPH$40 OP Substance Abuse Care - SPC_ Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $40 to $95 Copayment for Medicare Covered Group Sessions $40 to $95 $95 OP Substance Abuse Care - OPH$40 OP Substance Abuse Care - SPC_ |
| Podiatry Services | In-Network: Copayment for Medicare-Covered Podiatry Services $0 Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $0 |
| Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: $20 per day for days 1 to 20 $214 per day for days 21 to 100 Out-of-Network: Skilled Nursing Facility Services: $20 per day for days 1 to 20 $214 per day for days 21 to 100 |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | $0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for necessary anesthesia with covered service up to unlimited per year.Out of Network$0 copayment for comprehensive oral evaluation or periodontal exam up to 1 every 3 years. $0 copayment for panoramic film or diagnostic x-rays up to 1 every 5 years. $0 copayment for bitewing x-rays, intraoral x-rays up to 1 set(s) per year. $0 copayment for emergency diagnostic exam up to 1 per year. $0 copayment for periodic oral exam, prophylaxis (cleaning) up to 2 per year. $0 copayment for periodontal maintenance up to 4 per year. $0 copayment for necessary anesthesia with covered service up to unlimited per year. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 Copayment for Routine Eye Exams $0
Eyewear: Copayment for Medicare-Covered Benefits $0 Copayment for Contact Lenses $0
Members must use Humana's Medicare Insight Network, a national network of providers, which includes standard or PLUS providers. The allowance for the standard network is $50 less than the PLUS network. Out-of-Network: Medicare Covered Eye Exams Services: Copayment for Medicare Covered Eye Exams $0 Copayment for Medicare Covered Eyewear $0 |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $0 Copayment for Routine Hearing Exams $0
Hearing Aids: Copayment for Hearing Aids $699 to $999
Out-of-Network: Medicare Covered Hearing Exams Services: Copayment for Medicare Covered Hearing Exams $0 |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit Out-of-Network: Medicare Covered Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0 |
