Humana Gold Choice H8145-089 (PFFS) is a Medicare Advantage (Part C) Plan by Humana.
This page features plan details for 2023 Humana Gold Choice H8145-089 (PFFS) H8145 – 089 – 0 available in Select Counties in IA, MN, MT, ND, SD, WY.
Humana Gold Choice H8145-089 (PFFS) is offered in the following locations.
Humana Gold Choice H8145-089 (PFFS) offers the following coverage and cost-sharing.
Insurer: | Humana |
Health Plan Deductible: | $0.00 |
MOOP: | $6,700 In and Out-of-network |
Drugs Covered: | Yes |
Ready to sign up for Humana Gold Choice H8145-089 (PFFS) ?
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$164.90 | $47.20 | $47.80 | $0.00 | $259.90 |
Humana Gold Choice H8145-089 (PFFS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $465.00 |
Initial Coverage Limit: | $4,660.00 |
Catastrophic Coverage Limit: | $7,400.00 |
Drug Benefit Type: | Basic |
Gap Coverage: | No |
Formulary Link: | Formulary Link |
Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
---|---|---|---|---|
$47.80 | $37.80 | $27.90 | $17.90 | $7.90 |
After you pay your $465.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $2.00 copay | $2.00 copay | $10.00 copay | |
2 (Generic) | $7.00 copay | $7.00 copay | $20.00 copay | |
3 (Preferred Brand) | 25% | 25% | 25% | |
4 (Non-Preferred Drug) | 25% | 25% | 25% | |
5 (Specialty Tier) | 25% | 25% | 25% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $6.00 copay | $0.00 copay | $30.00 copay | |
2 (Generic) | $21.00 copay | $0.00 copay | $60.00 copay | |
3 (Preferred Brand) | 25% | 25% | 25% | |
4 (Non-Preferred Drug) | 25% | 25% | 25% | |
5 (Specialty Tier) |
After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
Drug Type | Cost Share |
---|---|
Generic drugs | $4.15 copay or 5% (whichever costs more) |
Brand-name drugs | $10.35 copay or 5% (whichever costs more) |
Humana Gold Choice H8145-089 (PFFS) also provides the following benefits.
In-Network: No |
Diagnostic services: | In-Network: $0 copay (limits may apply) |
Diagnostic services: | Out-of-Network: $0 copay (limits may apply) |
Endodontics: | In-Network: $0 copay (limits may apply) |
Endodontics: | Out-of-Network: $0 copay (limits may apply) |
Extractions: | In-Network: $0 copay (limits may apply) |
Extractions: | Out-of-Network: $0 copay (limits may apply) |
Non-routine services: | In-Network: $0 copay (limits may apply) |
Non-routine services: | Out-of-Network: $0 copay (limits may apply) |
Periodontics: | In-Network: $0 copay (limits may apply) |
Periodontics: | Out-of-Network: $0 copay (limits may apply) |
Prosthodontics, other oral/maxillofacial surgery, other services: | In-Network: $0 copay (limits may apply) |
Prosthodontics, other oral/maxillofacial surgery, other services: | Out-of-Network: $0 copay (limits may apply) |
Restorative services: | In-Network: $0 copay (limits may apply) |
Restorative services: | Out-of-Network: $0 copay (limits may apply) |
Cleaning: | In-Network: $0 copay (limits may apply) |
Cleaning: | Out-of-Network: $0 copay (limits may apply) |
Dental x-ray(s): | In-Network: $0 copay (limits may apply) |
Dental x-ray(s): | Out-of-Network: $0 copay (limits may apply) |
Fluoride treatment: | In-Network: $0 copay (limits may apply) |
Fluoride treatment: | Out-of-Network: $0 copay (limits may apply) |
Oral exam: | In-Network: $0 copay (limits may apply) |
Oral exam: | Out-of-Network: $0 copay (limits may apply) |
Diagnostic radiology services (e.g., MRI): | In-Network: $0-250 copay |
Diagnostic radiology services (e.g., MRI): | Out-of-Network: 30% coinsurance |
Diagnostic tests and procedures: | In-Network: $0-100 copay |
Diagnostic tests and procedures: | Out-of-Network: $0 copay or 30% coinsurance |
Lab services: | In-Network: $0-40 copay |
Lab services: | Out-of-Network: 30% coinsurance |
Outpatient x-rays: | In-Network: $20-100 copay |
Outpatient x-rays: | Out-of-Network: 30% coinsurance |
Primary: | In-Network: $20 copay per visit |
Primary: | Out-of-Network: 30% coinsurance per visit |
Specialist: | In-Network: $50 copay per visit |
Specialist: | Out-of-Network: 30% coinsurance per visit |
Emergency: | $95 copay per visit (always covered) |
Urgent care: | $25 copay per visit (always covered) |
Foot exams and treatment: | In-Network: $50 copay |
Foot exams and treatment: | Out-of-Network: 30% coinsurance |
Routine foot care: | Not covered |
In-Network: $290 copay | |
Out-of-Network: $290 copay |
$0.00 |
In-Network: No |
Fitting/evaluation: | Not covered (no limits) |
Hearing aids – inner ear: | Not covered (no limits) |
Hearing aids – outer ear: | Not covered (no limits) |
Hearing aids – over the ear: | Not covered (no limits) |
Hearing exam: | In-Network: $50 copay |
Hearing exam: | Out-of-Network: 30% coinsurance |
In-Network: $454 per day for days 1 through 4 $0 per day for days 5 through 90 $0 per day for days 91 and beyond | |
Out-of-Network: 30% per stay |
In-Network: $0-250 copay per visit | |
Out-of-Network: 30% coinsurance per visit |
$6,700 In and Out-of-network |
Diabetes supplies: | In-Network: $0 copay or 10-20% coinsurance per item |
Diabetes supplies: | Out-of-Network: 20-30% coinsurance per item |
Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 20% coinsurance per item |
Durable medical equipment (e.g., wheelchairs, oxygen): | Out-of-Network: 20% coinsurance per item |
Prosthetics (e.g., braces, artificial limbs): | In-Network: 20% coinsurance per item |
Prosthetics (e.g., braces, artificial limbs): | Out-of-Network: 30% coinsurance per item |
Chemotherapy: | In-Network: 12% coinsurance |
Chemotherapy: | Out-of-Network: 30% coinsurance |
Other Part B drugs: | In-Network: 12% coinsurance |
Other Part B drugs: | Out-of-Network: 30% coinsurance |
Inpatient hospital – psychiatric: | In-Network: $405 per day for days 1 through 4 $0 per day for days 5 through 90 |
Inpatient hospital – psychiatric: | Out-of-Network: 30% per stay |
Outpatient group therapy visit: | In-Network: $0 copay |
Outpatient group therapy visit: | Out-of-Network: 30% coinsurance |
Outpatient group therapy visit with a psychiatrist: | In-Network: $0 copay |
Outpatient group therapy visit with a psychiatrist: | Out-of-Network: 30% coinsurance |
Outpatient individual therapy visit: | In-Network: $0 copay |
Outpatient individual therapy visit: | Out-of-Network: 30% coinsurance |
Outpatient individual therapy visit with a psychiatrist: | In-Network: $0 copay |
Outpatient individual therapy visit with a psychiatrist: | Out-of-Network: 30% coinsurance |
Yes |
In-Network: $0 copay | |
Out-of-Network: $0 copay or 30% coinsurance |
Occupational therapy visit: | In-Network: $40 copay |
Occupational therapy visit: | Out-of-Network: 30% coinsurance |
Physical therapy and speech and language therapy visit: | In-Network: $40 copay |
Physical therapy and speech and language therapy visit: | Out-of-Network: 30% coinsurance |
In-Network: $0 per day for days 1 through 20 $196 per day for days 21 through 55 $0 per day for days 56 through 100 | |
Out-of-Network: 30% per stay |
Not covered |
Contact lenses: | Not covered (no limits) |
Eyeglass frames: | Not covered (no limits) |
Eyeglass lenses: | Not covered (no limits) |
Eyeglasses (frames and lenses): | Not covered (no limits) |
Other: | Not covered (no limits) |
Routine eye exam: | Not covered (no limits) |
Upgrades: | Not covered |
Covered |
Eye exams: | Monthly Premium: | $16.10 |
Eye exams: | Deductible: | N/A |
Eyewear: | Monthly Premium: | $16.10 |
Eyewear: | Deductible: | N/A |
Preventive dental: | Monthly Premium: | $45.70 |
Preventive dental: | Deductible: | N/A |
Comprehensive dental: | Monthly Premium: | $45.70 |
Comprehensive dental: | Deductible: | N/A |
Ready to sign up for Humana Gold Choice H8145-089 (PFFS) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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