Humana Gold Choice H8145-055 (PFFS)

H8145 - 055 - 0
4 out of 5 stars (4 / 5)

humana medicare provider logo

Humana Gold Choice H8145-055 (PFFS) is a Medicare Advantage (Part C) Plan by Humana.

This page features plan details for 2024 Humana Gold Choice H8145-055 (PFFS) H8145 – 055 – 0 available in Select counties in Pennsylvania.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

Humana Gold Choice H8145-055 (PFFS) is offered in the following locations.

Plan Overview

Humana Gold Choice H8145-055 (PFFS) offers the following coverage and cost-sharing.

Insurer:Humana
Health Plan Deductible:$0.00
MOOP:$
Drugs Covered:No

Ready to sign up for Humana Gold Choice H8145-055 (PFFS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

Humana Gold Choice H8145-055 (PFFS) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$174.70 $0.00 $0.00 $174.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Humana Gold Choice H8145-055 (PFFS) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$6,700 In and Out-of-network

Optional supplemental benefits

Yes

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

In-network $0-390 copay per visit (Authorization is not required.) (Referral is not required.)
out-of-network $0-390 copay per visit (Authorization is not required.) (Referral is not required.)

Doctor visits

In-network Primary$10 copay per visit (Not applicable.) (Not applicable.)
out-of-network Primary$10 copay per visit (Not applicable.) (Not applicable.)
In-network Specialist$30 copay per visit (Authorization is not required.) (Referral is not required.)
out-of-network Specialist$30 copay per visit (Authorization is not required.) (Referral is not required.)

Preventive care

In-network $0 copay (Authorization is not required.) (Referral is not required.)
out-of-network $0 copay (Authorization is not required.) (Referral is not required.)

Emergency care/Urgent care

Emergency$90 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$55 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

In-network Diagnostic tests and procedures$0-105 copay (Authorization is not required.) (Referral is not required.)
out-of-network Diagnostic tests and procedures$0-105 copay (Authorization is not required.) (Referral is not required.)
In-network Lab services$0-55 copay (Authorization is not required.) (Referral is not required.)
out-of-network Lab services$0-55 copay (Authorization is not required.) (Referral is not required.)
In-network Diagnostic radiology services (e.g., MRI)$0-300 copay (Authorization is not required.) (Referral is not required.)
out-of-network Diagnostic radiology services (e.g., MRI)$0-300 copay (Authorization is not required.) (Referral is not required.)
In-network Outpatient x-rays$10-100 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient x-rays$10-100 copay (Authorization is not required.) (Referral is not required.)

Hearing

In-network Hearing exam$30 copay (Authorization is not required.) (Referral is not required.)
out-of-network Hearing exam$30 copay (Authorization is not required.) (Referral is not required.)
In-network Fitting/evaluation$0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.)
out-of-network Fitting/evaluation50% coinsurance (There are no limits.) (Authorization is not required.) (Referral is not required.)
In-network Hearing aids$699-999 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Hearing aids50% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Preventive dental

In-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Oral exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Cleaning$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Fluoride treatment$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Dental x-ray(s)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Diagnostic services$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Diagnostic services$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Restorative services$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Restorative services$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
EndodonticsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Periodontics$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Periodontics$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
ExtractionsNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Vision

In-network Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Routine eye exam$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
In-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Contact lenses$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
In-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
out-of-network Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Eyeglass framesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Eyeglass lensesNot covered (There are no limits.) (Not applicable.) (Not applicable.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

In-network Occupational therapy visit$20-40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Occupational therapy visit$20-40 copay (Authorization is not required.) (Referral is not required.)
In-network Physical therapy and speech and language therapy visit$20-40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Physical therapy and speech and language therapy visit$20-40 copay (Authorization is not required.) (Referral is not required.)

Ground ambulance

In-network $270 copay (Not applicable.) (Not applicable.)
out-of-network $270 copay (Not applicable.) (Not applicable.)

Transportation

Not covered (Not applicable.) (Not applicable.)

Foot care (podiatry services)

In-network Foot exams and treatment$30 copay (Authorization is not required.) (Referral is not required.)
out-of-network Foot exams and treatment$30 copay (Authorization is not required.) (Referral is not required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

In-network Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is not required.) (Not applicable.)
out-of-network Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item (Authorization is not required.) (Not applicable.)
In-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is not required.) (Not applicable.)
out-of-network Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is not required.) (Not applicable.)
In-network Diabetes supplies$0 copay or 10-20% coinsurance per item (Authorization is not required.) (Not applicable.)
out-of-network Diabetes supplies10-20% coinsurance per item (Authorization is not required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is not required.) (Referral is not required.)

Medicare Part B drugs

In-network Chemotherapy0-20% coinsurance (Authorization is not required.) (Not applicable.)
out-of-network Chemotherapy20% coinsurance (Authorization is not required.) (Not applicable.)
In-network Other Part B drugs0-20% coinsurance (Authorization is not required.) (Not applicable.)
out-of-network Other Part B drugs20% coinsurance (Authorization is not required.) (Not applicable.)
In-network Part B Insulin drugs0-20% coinsurance (up to $35) (Authorization is not required.) (Not applicable.)
out-of-network Part B Insulin drugs20% coinsurance (Authorization is not required.) (Not applicable.)

Inpatient hospital coverage

In-network $390 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 90 and beyond (Authorization is not required.) (Referral is not required.)
out-of-network $390 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is not required.) (Referral is not required.)

Mental health services

In-network Inpatient hospital – psychiatric$390 per day for days 1 through 4
$0 per day for days 5 through 90 (Authorization is not required.) (Referral is not required.)
out-of-network Inpatient hospital – psychiatric$390 per day for days 1 through 4
$0 per day for days 5 through 90 (Authorization is not required.) (Referral is not required.)
In-network Outpatient group therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient group therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
In-network Outpatient individual therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit with a psychiatrist$40 copay (Authorization is not required.) (Referral is not required.)
In-network Outpatient group therapy visit$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient group therapy visit$40 copay (Authorization is not required.) (Referral is not required.)
In-network Outpatient individual therapy visit$40 copay (Authorization is not required.) (Referral is not required.)
out-of-network Outpatient individual therapy visit$40 copay (Authorization is not required.) (Referral is not required.)

Skilled Nursing Facility

In-network $0 per day for days 1 through 20
$178 per day for days 21 through 100 (Authorization is not required.) (Referral is not required.)
out-of-network $0 per day for days 1 through 20
$178 per day for days 21 through 100 (Authorization is not required.) (Referral is not required.)

Package #1

Monthly Premium$44.50
Deductiblenan

Package #2

Monthly Premium$53.60
Deductiblenan

Optional Benefits

Package #1

Preventive dental:Monthly Premium:$18.00
Preventive dental:Deductible:N/A
Comprehensive dental:Monthly Premium:$18.00
Comprehensive dental:Deductible:N/A

Package #2

Preventive dental:Monthly Premium:$21.20
Preventive dental:Deductible:$50.00
Comprehensive dental:Monthly Premium:$21.20
Comprehensive dental:Deductible:$50.00
Eye exams:Monthly Premium:$21.20
Eye exams:Deductible:$50.00
Eyewear:Monthly Premium:$21.20
Eyewear:Deductible:$50.00

Package #3

Preventive dental:Monthly Premium:$22.50
Preventive dental:Deductible:N/A
Comprehensive dental:Monthly Premium:$22.50
Comprehensive dental:Deductible:N/A

Package #4

Preventive dental:Monthly Premium:$28.90
Preventive dental:Deductible:N/A
Comprehensive dental:Monthly Premium:$28.90
Comprehensive dental:Deductible:N/A

Package #5

Preventive dental:Monthly Premium:$35.70
Preventive dental:Deductible:N/A
Comprehensive dental:Monthly Premium:$35.70
Comprehensive dental:Deductible:N/A

Ready to sign up for Humana Gold Choice H8145-055 (PFFS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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