Humana Gold Choice H8145-006 (PFFS)

4 out of 5 stars* for plan year 2024
$40.00 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

$40.00 Monthly Premium

Wisconsin, Montana, Missouri, North Dakota, Kansas, Oklahoma, South Dakota, Minnesota, Illinois, Iowa and Michigan 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 Wisconsin, Montana, Missouri, North Dakota, Kansas, Oklahoma, South Dakota, Minnesota, Illinois, Iowa and Michigan 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$40.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$545.00
Out-of-pocket maximum($1.00)
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$8,000.00
Primary care doctor visitIn-Network:

Doctor Office Visit:
Copayment for Primary Care Office Visit $0.00
Specialty doctor visit
Out-of-Network:

Doctor Specialty Visit:
Copayment for Medicare Covered Physician Specialist Office Visit $50.00
Inpatient hospital careIn-Network:

Acute Hospital Services:
$150.00 per day for days 1 to 7
$0.00 per day for days 8 to 90
Urgent care
Urgent Care:
Copayment for Urgent Care $55.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $100.00
Emergency room visit
Emergency Care:
Copayment for Emergency Care $100.00

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $100.00
Copayment for Worldwide Emergency Transportation $100.00
Ambulance transportationIn-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $300.00

Air Ambulance:
Coinsurance for Air Ambulance Services 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 servicesIn-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $15.00
Diabetes supplies, training, nutrition therapy and monitoringIn-Network:

Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0.00
Coinsurance for Medicare-covered Diabetic Supplies 10% to 20%
Copayment for Medicare-covered Diabetic Therapeutic Shoes or Inserts $0.00
Diabetic Supplies and Services limited to those from specified manufacturers(Please see Evidence of Coverage)
Durable medical equipment (DME)
Out-of-Network:

Durable Medical Equipment:
Coinsurance for Medicare Covered Durable Medical Equipment 20%
Diagnostic tests, lab and radiology services, and X-rays
Out-of-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare Covered Diagnostic Procedures/Tests $0.00 to $95.00
Copayment for Medicare Covered Lab Services $0.00 to $40.00
Copayment for Medicare Covered Diagnostic Radiological Services $0.00 to $300.00
Coinsurance for Medicare Covered Diagnostic Radiological Services 20%
Coinsurance for Medicare Covered Therapeutic Radiological Services 20%
Copayment for Medicare Covered Outpatient X-Ray Services $0.00 to $125.00
Home health care
Out-of-Network:

Home Health Services:
Copayment for Medicare Covered Home Health $0.00
Mental health inpatient careIn-Network:

Psychiatric Hospital Services:
$150.00 per day for days 1 to 7
$0.00 per day for days 8 to 90
Mental health outpatient care
Out-of-Network:

Outpatient Mental Health Services:
Copayment for Medicare Covered Individual Sessions $40.00
Copayment for Medicare Covered Group Sessions $40.00
Outpatient services/surgery
Out-of-Network:

Outpatient Hospital and ASC Services:
Copayment for Medicare Covered Outpatient Hospital Services $0.00 to $300.00
Copayment for Medicare Covered Ambulatory Surgical Center Services $0.00 to $250.00
Outpatient substance abuse care
Out-of-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual or Group Sessions $40.00 to $95.00
Over-the-counter itemsIn-Network:

Over-The-Counter (OTC) Items:
Copayment for Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $175.00 every three months
Nicotine Replacement Therapy (NRT) offerred as a Part C OTC benefit
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $50.00
Skilled Nursing Facility (SNF) care
Out-of-Network:
$0.00 per day for days 1 to 20
$203.00 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 careIn Network:
Plan covers up to $4,000 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, implants, etc. Note: The allowance cannot be used on cosmetic services.

Out of Network:
Plan covers up to $4,000 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, implants, etc. Note: The allowance cannot be used on cosmetic services. 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 benefits
Out-of-Network:

Medicare Covered Vision Services:
Copayment for Medicare Covered Eye Exams $0.00 to $50.00
Copayment for Medicare Covered Eyewear $20.00
Non-Medicare Covered Vision Services:
Copayment for Non-Medicare Covered Eye Exams $0.00
Copayment for Non-Medicare Covered Eyewear $0.00

Hearing Benefits

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

Coverage Details
Hearing benefitsIn-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $50.00
Copayment for Routine Hearing Exams $0.00
  • Maximum 1 visit every year
Copayment for Fitting/Evaluation for Hearing Aid $0.00

Hearing Aids:
Copayment for Hearing Aids $699.00 to $999.00
  • Maximum 2 Hearing Aids every year
$699 copayment for each Advanced level hearing aid up to 1 per ear per year. $999 copayment for each Premium level hearing aid up to 1 per ear per year. Note: Includes 80 batteries per aid and 3 year warranty. Unlimited follow-up provider visits during first year following TruHearing hearing aid purchase.

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 Zero Dollar Preventive Services:
Copayment for Medicare Covered Medicare-covered Preventive Services $0.00

Prescription Drug Costs and Coverage

The Humana Gold Choice H8145-006 (PFFS) offers prescription drug coverage, with an annual drug deductible of $545.00 (excludes Tiers 1 and 2)

Coverage
Cost
Coverage & Cost
Annual drug deductible$545.00 (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$545.00 (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$545.00 (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 Wisconsin, Montana, Missouri, North Dakota, Kansas, Oklahoma, South Dakota, Minnesota, Illinois, Iowa and Michigan 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 Wisconsin, Montana, Missouri, North Dakota, Kansas, Oklahoma, South Dakota, Minnesota, Illinois, Iowa and Michigan that offer similar benefits at similar or lower prices than the plan above. Call 1-855-298-6309 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

    Plan Documents

    Links to plan documents

    Wisconsin Counties Served

    Adams Brown Clark Dane Dodge Eau Claire Fond Du Lac Forest Green Lake Jefferson Juneau Kenosha Lafayette Langlade Lincoln Manitowoc Marathon Marquette Milwaukee Oneida Outagamie Ozaukee Racine Richland Sauk Shawano Sheboygan Trempealeau Vilas Walworth Washington Waukesha Waupaca Winnebago

    Montana Counties Served

    Carbon Cascade Chouteau Divide Flathead Judith Basin Mckenzie Pondera Ravalli Rosebud Silver Bow Teton

    Missouri Counties Served

    Atchison Barry Benton Bollinger Boone Butler Callaway Camden Carroll Carter Cedar Chariton Christian Clay Cole Crawford Dade Dallas Dekalb Douglas Greene Grundy Henry Hickory Holt Jackson Jasper Jefferson Laclede Lawrence Lewis Macon Marion Mercer Miller Mississippi Montgomery Newton Ozark Pemiscot Perry Phelps Pike Platte Polk Pulaski Ralls Reynolds Saint Charles Saint Clair Saint Louis Saint Louis City Stoddard Stone Taney Vernon Wright

    North Dakota Counties Served

    Burleigh

    Kansas Counties Served

    Chase Jewell Lyon Mitchell Norton Phillips Riley Smith

    Oklahoma Counties Served

    Atoka Choctaw Mccurtain

    South Dakota Counties Served

    Davison Hanson Keya Paha Union Yankton

    Minnesota Counties Served

    Blue Earth Brown Deuel Faribault Fillmore Freeborn Goodhue Houston Martin Mower Nicollet Rice Roberts Sibley Steele Wabasha Waseca Winona

    Illinois Counties Served

    Bond Boone Bureau Carroll Clark Clinton Cook Crawford Dewitt Douglas Edwards Gallatin Greene Grundy Hardin Iroquois Jo Daviess Johnson Kane Kankakee Kendall Knox La Salle Lawrence Lee Logan Madison Mason Mchenry Mclean Montgomery Ogle Peoria Pike Pope Richland Rock Island Saint Clair Sangamon Schuyler Stephenson Tazewell Union Wabash Washington Wayne White Winnebago

    Iowa Counties Served

    Adams Audubon Burt Calhoun Carroll Cherokee Dickinson Emmet Harrison Ida Louisa Lyon Pocahontas Sac Sioux Van Buren Webster

    Michigan Counties Served

    Allegan Antrim Barry Berrien Calhoun Cass Delta Dickinson Eaton Hillsdale Houghton Kalamazoo Kalkaska Kent Lenawee Marquette Menominee Montcalm Muskegon Ottawa Saint Joseph Shiawassee Van Buren Wexford

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

    Back to plans

    Every 60 seconds, we help someone enroll in a Medicare Advantage plan.1

    Ready to find your plan?

    Or call a licensed insurance agent

    1-855-298-6309

    TTY 711, 24/7

    Or call a licensed insurance agent

    • secure website