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Humana Gold Choice H8145-042 (PFFS) Medicare Advantage Plan H8145-042 • 2027

CMS Rating: ☆☆☆☆☆ (4.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$150
Maximum Out-of-Pocket
$9850.00In-network
Part B Giveback
Not offered
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
289 beneficiaries
Last update:

Humana Gold Choice H8145-042 (PFFS) Introduction

Humana Gold Choice H8145-042 is a Medicare Advantage PFFS plan offered by Humana. It uses a Medicare Private Fee-for-Service (PFFS) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $150 medical deductible, and $9850.00 in-network maximum out-of-pocket. CMS Plan ID H8145-042 identifies this plan.

Plan Benefits

Humana Gold Choice H8145-042 has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H8145-042.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Specialist In-network: $50 copay
Out-of-network: $50 copay		 In-network: $30 copay
Out-of-network: $30 copay

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Telehealth benefit In-network: $0-$50 copay In-network: $0-$40 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Out-of-network: $0 copay
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits Not covered In-network: $0 copay
Out-of-network: $0 copay
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$345 copay
Out-of-network: $0-$345 copay		 In-network: $0-$335 copay
Out-of-network: $0-$335 copay
Lab services In-network: $0 copay
Out-of-network: $0-$50 copay		 In-network: $0-$50 copay
Out-of-network: $0-$50 copay
Outpatient x-rays In-network: $0-$145 copay
Out-of-network: $0-$145 copay		 In-network: $0-$130 copay
Out-of-network: $0-$130 copay
Diagnostic tests and procedures In-network: $0-$175 copay
Out-of-network: $0-$175 copay		 In-network: $0-$120 copay
Out-of-network: $0-$120 copay

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $115 copay $115 copay
Worldwide emergency care Coming soon $115 copay
Urgent care $40 copay $40 copay
Inpatient hospital care In-network:
Tier 1
$375 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$375 per day for days 1-7
$0 per day for days 8-90
$0 per stay		 In-network:
Tier 1
$345 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$345 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Skilled Nursing Facility In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
$0 per day for days 1-20
$221 per day for days 21-100
$0 per stay		 In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-100
Out-of-network:
$0 per day for days 1-20
$218 per day for days 21-100
$0 per stay
Ground ambulance In-network: $325 copay
Out-of-network: $325 copay		 In-network: $335 copay
Out-of-network: $335 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $35 copay
Out-of-network: $35 copay		 In-network: $35 copay
Out-of-network: $35 copay
Outpatient group therapy In-network: $35 copay
Out-of-network: $35 copay		 In-network: $35 copay
Out-of-network: $35 copay
Inpatient psychiatric hospital care In-network:
Tier 1
$375 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$375 per day for days 1-7
$0 per day for days 8-90
$0 per stay		 In-network:
Tier 1
$345 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$345 per day for days 1-7
$0 per day for days 8-90
$0 per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $25 copay
Out-of-network: $25 copay		 In-network: $15-$35 copay
Out-of-network: $15-$35 copay
Occupational therapy In-network: $25 copay
Out-of-network: $25 copay		 In-network: $15-$35 copay
Out-of-network: $15-$35 copay

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: $0 copay, 10%-20% coinsurance
Out-of-network: 10%-20% coinsurance		 In-network: $0 copay, 10%-20% coinsurance
Out-of-network: 10%-20% coinsurance
Durable medical equipment In-network: 20% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay, 20% coinsurance
Out-of-network: $0 copay, 20% coinsurance
Prosthetics In-network: 20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 20% coinsurance
Out-of-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 20% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Cleaning In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Periodontics In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Endodontics In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Restorative services In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Contact lenses In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames only Not covered Not covered
Eyeglass lenses only Not covered Not covered
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: $0 copay		 In-network: $0 copay
Out-of-network: $0 copay
Upgrades Not covered Not covered

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay
Out-of-network: 95% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Fitting/evaluation In-network: $0 copay
Out-of-network: 95% coinsurance		 In-network: $0 copay
Out-of-network: $0 copay
Prescription hearing aids In-network: $199-$475 copay
Out-of-network: 95% coinsurance		 In-network: $99-$399 copay
Out-of-network: $99-$399 copay
OTC hearing aids Not covered In-network: $0 copay
Out-of-network: $0 copay

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by Humana Gold Choice H8145-042 as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Performance Ratings (Contract ID: H8145)

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.

2027 Medicare Star Ratings for Contract H8145
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Plan Availability

Humana Gold Choice H8145-042 (H8145-042-0) is available in the following locations:

Virginia Counties Served

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About Humana Gold Choice H8145-042 (PFFS)

How much does plan H8145-042 cost per month?

The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.

What is the annual out-of-pocket maximum (MOOP) for this plan?

The annual in-network MOOP is $9850.00 for 2027. After this limit is reached, covered in-network services are fully paid.

How many beneficiaries are enrolled in this plan?

CMS reports 289 beneficiaries enrolled in this plan.

What is the prescription drug deductible for 2027?

For 2027, the prescription drug deductible is $0.00.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services November 10, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services November 10, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services November 10, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services November 10, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Humana (official source) http://www.humana.com/medicare October 4, 2026
Medicare.gov Understanding Medicare Advantage Plans 25 May, 2025
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You 25 May, 2025
Medicare.gov Explore your Medicare coverage options 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.