2027 Medicare Advantage plan

Humana Gold Choice H8145-052 (PFFS): 2027 benefits and costs

Humana PFFS

CMS plan ID: H8145-052-0 · Plan year: 2027

Humana Gold Choice H8145-052 (PFFS) is a 2027 Medicare Advantage plan offered by Humana. It is listed in Kentucky, Pennsylvania, West Virginia.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$700.00

Organization: Humana
Plan organization: HUMANA INSURANCE COMPANY
Parent company: Humana Inc.
Plan type: PFFS
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
Combined in/out-of-network medical deductible: None
Out-of-network medical deductible: None
In-network medical maximum: Not applicable
Combined in/out-of-network medical maximum: $9,850.00
Applies to certain in-network supplemental services.
Out-of-network medical maximum: Not applicable

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	Out-of-network	What to know
Primary care doctor	$0.00 copay Service-specific deductible No	$0.00 copay Deductible applies No
Specialist visit	$45.00 copay Service-specific deductible No	50% coinsurance Deductible applies No
Telehealth	$0.00 to $45.00 copay Service-specific deductible No	Not summarized. Check coverage with the plan.
Emergency care	$115.00 copay	Not summarized. Check coverage with the plan.
Urgent care	$40.00 copay	Not summarized. Check coverage with the plan.
Home health	$0.00 copay Service-specific deductible No	50% coinsurance Deductible applies No	Approval required No Referral required No
Dialysis	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	50% coinsurance Deductible applies No
Other Part B drugs	0% to 20% coinsurance Deductible applies No	20% to 50% coinsurance Deductible applies No
Kidney disease education services	$0.00 copay Service-specific deductible No	$0.00 copay Deductible applies No
Medicare-covered chiropractic	$15.00 copay Service-specific deductible No	50% coinsurance Deductible applies No
Medicare-covered foot care	$45.00 copay Service-specific deductible No	50% coinsurance Deductible applies No
Other health professionals	$0.00 to $45.00 copay Service-specific deductible No	$0.00 copay; 50% coinsurance Deductible applies No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–6: $405.00 copay per day Days 7–90: $0.00 copay per day	Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–5: $325.00 copay per day Days 6–90: $0.00 copay per day	Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day	Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	Out-of-network
Outpatient hospital care	$0.00 to $900.00 copay Service-specific deductible No	$0.00 to $35.00 copay; 50% coinsurance Deductible applies No
Hospital observation services	$405.00 copay Service-specific deductible No	$405.00 copay Deductible applies No
Ambulatory surgical center	$0.00 to $750.00 copay Service-specific deductible No	$0.00 copay; 50% coinsurance Deductible applies No
Outpatient blood	$0.00 copay Service-specific deductible No	$0.00 copay Deductible applies No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	Out-of-network
Diagnostic procedures and tests	$0.00 to $175.00 copay Service-specific deductible No	$0.00 to $40.00 copay; 50% coinsurance Deductible applies No
Laboratory services	$0.00 copay Service-specific deductible No	$40.00 copay; 50% coinsurance Deductible applies No
Diagnostic radiology (CT, MRI)	$0.00 to $780.00 copay Service-specific deductible No	$0.00 copay; 50% coinsurance Deductible applies No
Therapeutic radiology	$45.00 copay; 20% coinsurance Service-specific deductible No	50% coinsurance Deductible applies No
X-rays	$0.00 to $145.00 copay Service-specific deductible No	$0.00 to $40.00 copay; 30% to 50% coinsurance Deductible applies No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	Out-of-network	What to know
Partial hospitalization	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No	Approval required No Referral required No
Intensive outpatient program	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No	Approval required No Referral required No
Substance use treatment, individual sessions	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No
Substance use treatment, group sessions	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No
Opioid treatment program	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No
Mental health, individual sessions	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No
Mental health, group sessions	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No
Psychiatry, individual sessions	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No
Psychiatry, group sessions	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	Out-of-network
Occupational therapy	$35.00 copay Service-specific deductible No	40% to 50% coinsurance Deductible applies No
Physical and speech therapy	$35.00 copay Service-specific deductible No	40% to 50% coinsurance Deductible applies No
Cardiac rehabilitation	$30.00 copay Service-specific deductible No	50% coinsurance Deductible applies No
Intensive cardiac rehabilitation	$30.00 copay Service-specific deductible No	50% coinsurance Deductible applies No
Pulmonary rehabilitation	$25.00 copay Service-specific deductible No	50% coinsurance Deductible applies No
Supervised exercise for peripheral artery disease	$20.00 copay Service-specific deductible No	50% coinsurance Deductible applies No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	Out-of-network
Ground ambulance	$325.00 copay Service-specific deductible No	$325.00 copay Deductible applies No
Air ambulance	20% coinsurance Service-specific deductible No	20% coinsurance Deductible applies No
Durable medical equipment	20% coinsurance Service-specific deductible No	50% coinsurance Deductible applies No
Prosthetic devices	20% coinsurance Service-specific deductible No	50% coinsurance Deductible applies No
Medical supplies	20% coinsurance Service-specific deductible No	50% coinsurance Deductible applies No
Diabetic supplies	$0.00 copay; 10% to 20% coinsurance Service-specific deductible No	20% to 50% coinsurance Deductible applies No
Diabetic shoes and inserts	$10.00 copay Service-specific deductible No	50% coinsurance Deductible applies No
Diabetic monitors	$0.00 copay; 10% to 20% coinsurance Service-specific deductible No	20% to 50% coinsurance Deductible applies No

Dental benefits

Dental benefits and member costs
Service	In-network	Out-of-network
Medicare-covered dental	$45.00 copay	50% coinsurance Deductible applies No
Oral examsAdditional plan benefit	$0.00 copay	$0.00 copay Deductible applies No
Dental X-raysAdditional plan benefit	$0.00 copay	$0.00 copay Deductible applies No
Dental cleaningAdditional plan benefit	$0.00 copay	$0.00 copay Deductible applies No
Gum treatment (periodontics)Additional plan benefit	$0.00 copay	$0.00 copay Deductible applies No
Other dental servicesAdditional plan benefit	$0.00 copay	$0.00 copay Deductible applies No

Additional network details

These costs apply to the listed service categories and networks.

Dental benefits: additional out-of-network or point-of-service benefits
Service	Network	Your share of the cost	What to know
Diagnostic and preventive dental (category)Additional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No
Comprehensive dental (category)Additional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No

Vision benefits

Vision benefits and member costs
Service	In-network	Out-of-network
Medicare-covered eye exams	$0.00 to $45.00 copay Service-specific deductible No	$0.00 copay; 50% coinsurance Deductible applies No
Routine eye examsAdditional plan benefit	$0.00 copay	$0.00 copay Deductible applies No
Medicare-covered eyewear	$0.00 copay Service-specific deductible No	$0.00 copay Deductible applies No
Contact lensesAdditional plan benefit	$0.00 copay	$0.00 copay Deductible applies No
Eyeglasses, lenses and framesAdditional plan benefit	$0.00 copay	$0.00 copay Deductible applies No

Additional network details

These costs apply to the listed service categories and networks.

Vision benefits: additional out-of-network or point-of-service benefits
Service	Network	Your share of the cost	What to know
Eye exams (category)Additional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No
Eyewear (category)Additional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No

Hearing benefits

Hearing benefits and member costs
Service	In-network	Out-of-network
Medicare-covered hearing exams	$45.00 copay Service-specific deductible No	50% coinsurance Deductible applies No
Routine hearing examsAdditional plan benefit	$0.00 copay	95% coinsurance Deductible applies No
Hearing aid fitting and evaluationAdditional plan benefit	$0.00 copay	95% coinsurance Deductible applies No
Prescription hearing aids (all types)Additional plan benefit	$575.00 to $750.00 copay Service-specific deductible No	95% coinsurance Deductible applies No

Additional network details

These costs apply to the listed service categories and networks.

Hearing benefits: additional out-of-network or point-of-service benefits
Service	Network	Your share of the cost	What to know
Hearing exams (category)Additional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No
Prescription hearing aids (category)Additional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No

Extra benefits

Extra benefits and member costs
Service	In-network	Out-of-network
Supplemental acupunctureAdditional plan benefit	$45.00 copay Service-specific deductible No	$45.00 copay Deductible applies No Dollar benefit limit applies No
Limited-duration mealsAdditional plan benefit	$0.00 copay Service-specific deductible No	95% coinsurance Deductible applies No Dollar benefit limit applies No
Annual physical examAdditional plan benefit	$0.00 copay Service-specific deductible No	$0.00 copay Deductible applies No Dollar benefit limit applies No
Fitness benefitAdditional plan benefit	$0.00 copay Service-specific deductible No	95% coinsurance Deductible applies No Dollar benefit limit applies No

Additional services and network costs

Additional network details

These costs apply to the listed service categories and networks.

Additional medical services: additional out-of-network or point-of-service benefits
Service	Network	Your share of the cost	What to know
Chiropractic ServicesAdditional plan benefit	Out-of-network	Confirm with the plan (copay); Confirm with the plan (coinsurance)	Dollar benefit limit applies No
Routine Chiropractic CareAdditional plan benefit	Out-of-network	$15.00 copay Deductible applies No
Podiatry Services - Routine Foot CareAdditional plan benefit	Out-of-network	$45.00 copay Deductible applies No	Dollar benefit limit applies No
Medicare-covered preventive servicesMedicare-covered care	Out-of-network	$0.00 copay Deductible applies No
Glaucoma ScreeningMedicare-covered care	Out-of-network	$0.00 copay Deductible applies No
Diabetes Self-Management TrainingMedicare-covered care	Out-of-network	$0.00 copay Deductible applies No
Digital Rectal ExamsMedicare-covered care	Out-of-network	$0.00 copay Deductible applies No
EKG after a Welcome to Medicare visitMedicare-covered care	Out-of-network	$0.00 copay Deductible applies No
Medicare Part B insulinMedicare-covered care	Out-of-network	20% to 50% coinsurance Deductible applies No

Allowances and optional benefits

Benefits for qualifying members

Virtual Cardiac Recovery Program

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Congestive Heart Failure (CHF); Hypertension; Other 1; Other 2
Qualifying conditions: Pneumonia
Qualifying conditions: Respiratory Illnesses
All listed conditions required: No
Combination of conditions required: No
Included services: Other 1
Applies to out-of-network or point-of-service care: Yes
Some package benefits are exempt from the deductible: No

Optional packages that cost extra

MyOption DEN972 $43.30 extra per month

MyOption DEN972

The limits below apply only to this optional package.

Benefit allowance: $1,500.00
How often this limit applies: Every year
Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?: No
Deductible applies: No
Included services: Oral Exams; Dental X-Rays; Dental cleaning; Restorative dental care; Root canal treatment (endodontics); Gum treatment (periodontics); Removable dentures (prosthodontics); Fixed dental restorations (prosthodontics); Oral and Maxillofacial Surgery; Adjunctive General Services

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Standard retail costs

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	100 days
Tier 1Preferred Generic	$0.00	$0.00
Tier 2Generic	$5.00	$15.00
Tier 3Preferred Brand	17%	17%
Tier 4Non-Preferred Drug	40%	40%
Tier 5Specialty Tier	25%	Not listed

Mail-order and other pharmacies

Out-of-network pricing: You pay the standard retail copay or coinsurance, plus any difference between the pharmacy’s billed charge and the amount the plan allows at a standard retail pharmacy.

Preferred mail order costs

Preferred mail order: initial-coverage cost per prescription fill
Drug tier	30 days	100 days
Tier 1Preferred Generic	$0.00	$0.00
Tier 2Generic	$5.00	$0.00
Tier 3Preferred Brand	17%	15%
Tier 4Non-Preferred Drug	40%	40%
Tier 5Specialty Tier	25%	Not listed

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier	30 days	100 days
Tier 1Preferred Generic	$10.00	$30.00
Tier 2Generic	$20.00	$60.00
Tier 3Preferred Brand	17%	17%
Tier 4Non-Preferred Drug	40%	40%
Tier 5Specialty Tier	25%	Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$5.00
Tier 3Preferred Brand	17%
Tier 4Non-Preferred Drug	40%
Tier 5Specialty Tier	25%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$5.00
Tier 3Preferred Brand	17%
Tier 4Non-Preferred Drug	40%
Tier 5Specialty Tier	25%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: No
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: No
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: No
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 3 states or territories. Availability can vary by county and ZIP code.

View all locations 59 county listings across 3 states or territories