Humana Gold Choice H8145-006 (PFFS) - H8145-006-000

4 out of 5 stars* for plan year 2025

$38.00

Monthly Premium

Humana Gold Choice H8145-006 (PFFS) is a PFFS Medicare Advantage (Medicare Part C) plan offered by Humana Inc.

Plan ID: H8145-006-000

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$38.00

Monthly Premium

Missouri, Illinois, Wisconsin, Iowa, Michigan, Montana, Kansas, Minnesota, North Dakota, South Dakota, and Oklahoma Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Missouri, Illinois, Wisconsin, Iowa, Michigan, Montana, Kansas, Minnesota, North Dakota, South Dakota, and Oklahoma Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage	Details
Monthly plan premium	$38.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible	$590.00
Out-of-pocket maximum	-$1.00
Initial drug coverage limit	$0.00
Catastrophic drug coverage limit	$2,000.00
Primary care doctor visit	Out-of-Network: Doctor Office Visit Services: Copayment for Medicare Covered Primary Care Office Visit $0
Specialty doctor visit	Out-of-Network: Doctor Specialty Visit Services: Copayment for Medicare Covered Physician Specialist Office Visit $55
Inpatient hospital care	In-Network: Acute Hospital Services: $230 per day for days 1 to 7 $0 per day for days 8 to 90
Urgent care	Urgent Care: Copayment for Urgent Care $45 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $110
Emergency room visit	Emergency Care: Copayment for Emergency Care $110 Worldwide Coverage: Copayment for Worldwide Emergency Coverage $110 Copayment for Worldwide Emergency Transportation $110
Ambulance transportation	Out-of-Network: Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $315 Coinsurance for Medicare Covered Ambulance Services - Air 20%

Health Care Services and Medical Supplies

Humana Gold Choice H8145-006 (PFFS) covers a range of additional benefits. Learn more about Humana Gold Choice H8145-006 (PFFS) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage	Details
Chiropractic services	In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15
Diabetes supplies, training, nutrition therapy and monitoring	In-Network: Diabetic Supplies and Services: Copayment for Medicare-covered Diabetic Supplies $0 Coinsurance for Medicare-covered Diabetic Supplies 10% Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0
Durable medical equipment (DME)	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	Out-of-Network: Medicare Covered Diagnostic Procedures/Tests Services: Copayment for Medicare Covered Diagnostic Procedures/Tests $0 to $95 Copayment for Medicare Covered Lab Services $0 to $55 Copayment for Medicare Covered Diagnostic Radiological Services $0 to $350 Coinsurance for Medicare Covered Diagnostic Radiological Services 20% Coinsurance for Medicare Covered Therapeutic Radiological Services 20% Copayment for Medicare Covered Outpatient X-Ray Services $0 to $150 $95 OP Diag Proc & Tests - OPH$0 OP Diag Proc & Tests - PCP$55 OP Diag Proc & Tests - SPC$45 OP Diag Proc & Tests - UCC$95 Sleep Study (Fac Based) - OPH$55 Sleep Study (Fac Based) - SPC$0 Sleep Study (Home Based) - Mbr's Home_
Home health care	In-Network: Home Health Services: Copayment for Medicare-covered Home Health Services $0
Mental health inpatient care	Out-of-Network: Psychiatric Hospital Services: $230 per day for days 1 to 7 $0 per day for days 8 to 90
Mental health outpatient care	Out-of-Network: Medicare Covered Mental Health Services: Copayment for Medicare Covered Individual Sessions $45 Copayment for Medicare Covered Group Sessions $45
Outpatient services/surgery	In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $350 $0 Diag Colonoscopy - OPH$95 Mental Health - OPH$350 Surgery Svcs - OPH$55 Wound Care - OPH_ Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $230 Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 to $300 $0 Diag Colonoscopy - ASC$300 Surgery Svcs - ASC_
Outpatient substance abuse care	In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $45 to $95 Copayment for Medicare-covered Group Sessions $45 to $95 $95 OP Substance Abuse Care - OPH$45 OP Substance Abuse Care - SPC_
Podiatry services	Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $55
Skilled Nursing Facility (SNF) care	Out-of-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $203 per day for days 21 to 100

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Dental care	Plan covers up to $3000 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire. Your benefit can be used for most dental treatments such as: Preventive dental services, such as exams, routine cleanings, etc. Basic dental services, such as fillings, extractions, etc. Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc. 30% coinsurance applies to dentures. 30% - 40% coinsurance applies to bridges and crowns. Frequency limits may apply. Note: The allowance cannot be used on fluoride, cosmetic services and implants. Out of Network Plan covers up to $3000 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire. Your benefit can be used for most dental treatments such as: Preventive dental services, such as exams, routine cleanings, etc. Basic dental services, such as fillings, extractions, etc. Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc. 30% coinsurance applies to dentures. 30% - 40% coinsurance applies to bridges and crowns. Frequency limits may apply. Note: The allowance cannot be used on fluoride, cosmetic services and implants. Benefits received out-of-network are subject to any in-network benefit maximums, limitations, and/or exclusions.

Coverage

Details

Dental care

Plan covers up to $3000 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire.
Your benefit can be used for most dental treatments such as:
Preventive dental services, such as exams, routine cleanings, etc.
Basic dental services, such as fillings, extractions, etc.
Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc.
30% coinsurance applies to dentures.
30% - 40% coinsurance applies to bridges and crowns.
Frequency limits may apply.
Note: The allowance cannot be used on fluoride, cosmetic services and implants.
Out of Network
Plan covers up to $3000 allowance every year for non-Medicare covered preventive and comprehensive dental services. You are responsible for any amount above the dental coverage limit. Any amount unused at the end of the year will expire.
Your benefit can be used for most dental treatments such as:
Preventive dental services, such as exams, routine cleanings, etc.
Basic dental services, such as fillings, extractions, etc.
Major dental services, such as periodontal scaling, crowns, dentures, root canals, bridges etc.
30% coinsurance applies to dentures.
30% - 40% coinsurance applies to bridges and crowns.
Frequency limits may apply.
Note: The allowance cannot be used on fluoride, cosmetic services and implants.
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, though there may be provider network restrictions. See the plan Evidence of Coverage

Coverage	Details
Vision care	In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 to $55 Copayment for Routine Eye Exams $0 Maximum 1 Routine Eye Exam every year Maximum Plan Benefit of $75 every year Eyewear: Copayment for Medicare-Covered Benefits $0 Copayment for Contact Lenses $0 Maximum 1 Pair every year Copayment for Eyeglasses (lenses and frames) $0 Maximum 1 Pair every year Maximum Plan Benefit of $100 every year 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.

Coverage

Details

Vision care

In-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0 to $55
Copayment for Routine Eye Exams $0

Maximum 1 Routine Eye Exam every year

Maximum Plan Benefit of $75 every year

Eyewear:
Copayment for Medicare-Covered Benefits $0
Copayment for Contact Lenses $0

Maximum 1 Pair every year

Copayment for Eyeglasses (lenses and frames) $0

Maximum 1 Pair every year

Maximum Plan Benefit of $100 every year
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.

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Hearing care	Out-of-Network: Medicare Covered Hearing Exams Services: Copayment for Medicare Covered Hearing Exams $55

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Preventive services and health/wellness education programs	Out-of-Network: Medicare Covered Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $0

Prescription Drug Costs and Coverage

The Humana Gold Choice H8145-006 (PFFS) offers prescription drug coverage, with an annual drug deductible of $590.00 (excludes Tiers 1 and 2)

Coverage & Cost 30 day supply 60 day supply 90 day supply
Coverage	Cost 30 day supply 60 day supply 90 day supply
Annual drug deductible	$590.00 (excludes Tiers 1 and 2)
Tier 1	Standard retail $6.00 Preferred mail order $6.00 Standard mail order $10.00
Tier 2	Standard retail $15.00 Preferred mail order $15.00 Standard mail order $20.00
Annual drug deductible	$590.00 (excludes Tiers 1 and 2)
Tier 1	Standard retail N/A Preferred mail order N/A Standard mail order N/A
Tier 2	Standard retail N/A Preferred mail order N/A Standard mail order N/A
Annual drug deductible	$590.00 (excludes Tiers 1 and 2)
Tier 1	Standard retail $18.00 Preferred mail order $0.00 Standard mail order $30.00
Tier 2	Standard retail $45.00 Preferred mail order $0.00 Standard mail order $60.00

When reviewing Missouri, Illinois, Wisconsin, Iowa, Michigan, Montana, Kansas, Minnesota, North Dakota, South Dakota, and Oklahoma Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Missouri, Illinois, Wisconsin, Iowa, Michigan, Montana, Kansas, Minnesota, North Dakota, South Dakota, and Oklahoma that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Missouri Counties Served

Illinois Counties Served

Wisconsin Counties Served

Iowa Counties Served

Michigan Counties Served

Montana Counties Served

Kansas Counties Served

Minnesota Counties Served

North Dakota Counties Served

Burleigh

South Dakota Counties Served

Oklahoma Counties Served

We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield*, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

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