Humana Gold Choice H8145-122 (PFFS) H8145-122-000 is a 2021 Medicare Advantage plan with drug coverage provided by Humana.

When it comes to cost-sharing, you’ll want to consider both monthly costs and out-of-pocket costs. This plan has a monthly premium of $131, which covers both the health and drug portions of the plan.

The drug plan portion of this plan provides Enhanced Alternative (EA) benefits, which are benefits that exceed the required standard.

When it comes to out-of-pocket costs for drugs, this plan has a Part D drug Deductible of $195.00 and an Initial Coverage Limit of $4130. Each drug tier may be subject to different cost-sharing in each coverage phase, so keep that in mind when considering out-of-pocket costs. Check out the drug formulary below for more information, or reach out to a licensed Medicare agent for help using the call number on this page. Alternatively, if you know what plan you want, you can enroll online yourself using our site as well.


Plan Basics
Contract Year 2021
Medicare Type Medicare Advantage Plan (Part C)
CMS Plan ID H8145-122-000
Plan Organization Humana
Plan Type PFFS
Plan Name Humana Gold Choice H8145-122 (PFFS)
Plan Organization Type PFFS
Drugs Covered Yes
Doctors Choice Plan Doctors for Most Services
Benefit Type Enhanced Alternative
Special Needs Plan No
Overall Star Rating 3.5
Plan Cost Sharing
Premium $131.00
Total Premium (Includes Part B) $266.50
Monthly Part C Premium $92.80
Monthly Part D Basic Premium $38.20
Monthly Part D Supplemental Premium $0.00
Monthly Part D Total Premium $38.20
Monthly Part D Premium Full Assistance $9.90
Monthly Part D Premium 75% Assistance $17.00
Monthly Part D Premium 50% Assistance $24.10
Monthly Part D Premium 25% Assistance $31.10
Part D Drug Deductible $195.00
Annual Drug Deductible $195.00
Tiers Excluded From Deductible 1
Part D Initial Coverage Limit $4130.00
Part D Catastrophic Coverage Threshold $6550.00
Maximum Out-of-Pocket Limit for Parts A & B (MOOP) $0.00
Gap Coverage No

Medicare Advantage Plan Health Benefits


Additional Benefits And/or Reduced Cost-sharing For Enrollees With Certain Health Conditions?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - No
Comprehensive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diagnostic services No - - - Not covered
Endodontics No - - - Not covered
Extractions Yes Out-of-Network - - 55-75% coinsurance
Non-routine services No - - - Not covered
Periodontics Yes Out-of-Network - - 55-75% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services No - - - Not covered
Restorative services Yes Out-of-Network - - 55-75% coinsurance
Diagnostic Procedures/lab Services/imaging
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diagnostic radiology services (e.g., MRI) - Out-of-Network - - $0 copay or 20% coinsurance
Diagnostic tests and procedures - Out-of-Network - - $0-20 copay
Lab services - Out-of-Network - - $0-20 copay
Outpatient x-rays - Out-of-Network - - $0-20 copay
Doctor Visits
Service Cap Network Auth. Req. Ref. Req. Cost Share
Primary - Out-of-Network - - $0 copay
Specialist - Out-of-Network - - $0 copay
Emergency Care/Urgent Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
Emergency - - - - $90 copay per visit (always covered)
Urgent care - - - - $0-20 copay per visit (always covered)
Foot Care (podiatry Services)
Service Cap Network Auth. Req. Ref. Req. Cost Share
Foot exams and treatment - Out-of-Network - - $0 copay
Routine foot care - - - - Not covered
Ground Ambulance
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network - - $290 copay
Health Plan Deductible
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $0
Hearing
Service Cap Network Auth. Req. Ref. Req. Cost Share
Fitting/evaluation Yes Out-of-Network - - $0 copay
Hearing aids Yes Out-of-Network - - $399-699 copay
Hearing exam - Out-of-Network - - $0 copay
Inpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network - - $0 copay per stay
Maximum Out-of-pocket Enrollee Responsibility (does Not Include Prescription Drugs)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $6,700 In and Out-of-network
Medical Equipment/supplies
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diabetes supplies - Out-of-Network - - $0 copay or 20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) - Out-of-Network - - 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) - Out-of-Network - - 20% coinsurance per item
Medicare Part B Drugs
Service Cap Network Auth. Req. Ref. Req. Cost Share
Chemotherapy - Out-of-Network - - 20% coinsurance
Other Part B drugs - Out-of-Network - - 20% coinsurance
Mental Health Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Inpatient hospital - psychiatric - Out-of-Network - - $0 copay per stay
Outpatient group therapy visit - Out-of-Network - - $0 copay
Outpatient group therapy visit with a psychiatrist - Out-of-Network - - $0 copay
Outpatient individual therapy visit - Out-of-Network - - $0 copay
Outpatient individual therapy visit with a psychiatrist - Out-of-Network - - $0 copay
Optional Supplemental Benefits
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - Yes
Other Health Plan Deductibles?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - No
Outpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network - - $0-40 copay per visit
Preventive Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network - - $0 copay
Preventive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Cleaning Yes Out-of-Network - - 50% coinsurance
Dental x-ray(s) Yes Out-of-Network - - 50% coinsurance
Fluoride treatment Yes Out-of-Network - - 50% coinsurance
Oral exam Yes Out-of-Network - - 50% coinsurance
Rehabilitation Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Occupational therapy visit - Out-of-Network - - $25 copay
Physical therapy and speech and language therapy visit - Out-of-Network - - $25 copay
Skilled Nursing Facility
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network - - $0 per day for days 1 through 20$184 per day for days 21 through 100
Transportation
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - Not covered
Vision
Service Cap Network Auth. Req. Ref. Req. Cost Share
Contact lenses Yes Out-of-Network - - $0 copay
Eyeglass frames No - - - Not covered
Eyeglass lenses No - - - Not covered
Eyeglasses (frames and lenses) Yes Out-of-Network - - $0 copay
Other No - - - Not covered
Routine eye exam Yes Out-of-Network - - $0 copay
Upgrades - - - - Not covered
Wellness Programs (e.g., Fitness, Nursing Hotline)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - Covered

Medicare Plan Packages


Package #1
Category Cost Sharing Type Cost Share
Comprehensive dental Monthly Premium $30.40
Preventive dental Monthly Premium $30.40
Plan Drug Info
Formulary Link Drug Formulary Directory
Official Medicare Contact
Medicare Phone 1-800-MEDICARE (1-800-633-4227)
Medicare TTY User 1-877-486-2048
Plan Available in these Counties
Anderson County, Kansas, Arkansas County, Arkansas, Atchison County, Kansas, Baxter County, Arkansas, Benton County, Arkansas, Bourbon County, Kansas, Butler County, Kansas, Caddo County, Oklahoma, Canadian County, Oklahoma, Carroll County, Arkansas, Cherokee County, Kansas, Cleburne County, Arkansas, Cleveland County, Oklahoma, Conway County, Arkansas, Craig County, Oklahoma, Craighead County, Arkansas, Crawford County, Arkansas, Crawford County, Kansas, Crittenden County, Arkansas, Cross County, Arkansas, Dallas County, Arkansas, Delaware County, Oklahoma, Faulkner County, Arkansas, Franklin County, Arkansas, Fulton County, Arkansas, Garland County, Arkansas, Grady County, Oklahoma, Greene County, Arkansas, Harvey County, Kansas, Haskell County, Oklahoma, Hot Spring County, Arkansas, Independence County, Arkansas, Jackson County, Arkansas, Jefferson County, Arkansas, Johnson County, Arkansas, Johnson County, Kansas, Johnston County, Oklahoma, Labette County, Kansas, Lawrence County, Arkansas, Leavenworth County, Kansas, Lee County, Arkansas, Logan County, Arkansas, Logan County, Oklahoma, Love County, Oklahoma, Marion County, Arkansas, Marshall County, Oklahoma, Mayes County, Oklahoma, Mcclain County, Oklahoma, Mcpherson County, Kansas, Montgomery County, Arkansas, Muskogee County, Oklahoma, Oklahoma County, Oklahoma, Okmulgee County, Oklahoma, Ottawa County, Oklahoma, Pope County, Arkansas, Pottawatomie County, Oklahoma, Pulaski County, Arkansas, Randolph County, Arkansas, Saline County, Arkansas, Scott County, Arkansas, Sebastian County, Arkansas, Sedgwick County, Kansas, Seminole County, Oklahoma, Tulsa County, Oklahoma, Van Buren County, Arkansas, Wagoner County, Oklahoma, Washington County, Arkansas

NOTE: Information on MedicarePolicyHelper.com is for educational purposes only. We are not affiliated with Medicare, or CMS. Medicare has not reviewed or endorsed the information on our site. All plan data on our site comes directly from medicare.gov and is subject to change.