- Entity
- plan:H8145-163-0
- Digest
- 2026-cms-snp-plan
- Source URL
- https://www.medicareplans.com/medicare-advantage/plan/H8145-163-0/
- Glossary Scope
- cms_landscape
- Fragment Scope
- semantic-digest
- Method
- https://webmem.com/protocol/serialization/html/
- fragment-H8145-163-0-performance
- CMS Plan ID
- All MA/MAPD and PDP plans have a CMS plan ID consisting of a contract ID, plan ID, and segment ID formatted like: H1234-001-0.
- Value
- H8145-163-0
- Derived
- true
- Contract Year
- The calendar year in which the plan's benefits, premiums, and rules are effective as defined by CMS.
- Value
- 2026
- Derived
- false
- Contract Category Type
- The CMS-assigned contract type for the plan, such as MA, MAPD, SNP, or PDP, which indicates the scope of services and population the contract is designed to serve.
- Value
- MA
- Derived
- false
- Contract ID
- The unique contract ID assigned to a carrier by CMS. All plans have a contract ID.
- Value
- H8145
- Derived
- false
- Plan ID
- The unique plan ID within a CMS contract.
- Value
- 163
- Derived
- false
- Segment ID
- A segment ID is used to identify specific geographic market segments or subdivisions for variations in benefits, costs, and premiums.
- Value
- 0
- Derived
- false
- Parent Organization Name
- The legal parent company that owns the Medicare Advantage contract and is ultimately responsible for the plan’s administration.
- Value
- Humana Inc.
- Derived
- false
- Organization Marketing Name
- The publicly marketed name of the Medicare Advantage plan carrier as displayed to consumers, which may differ from the legal or corporate entity name.
- Value
- Humana
- Derived
- false
- Organization Type
- A descriptive label that classifies the Medicare plan contract type in plain language, such as Local HMO, Regional PPO, or SNP.
- Value
- Private Fee-For-Service
- Derived
- true
- Plan Name
- The official name of the Medicare Advantage plan as listed in CMS source data.
- Value
- Humana Gold Choice H8145-163 (PFFS)
- Derived
- false
- Plan Type
- The type of Medicare plan, such as PDP, Regional PPO, HMO-POS, HMO D-SNP, which determines how the plan manages care and provider access.
- Value
- PFFS
- Derived
- false
- Special Needs Plan (SNP) Indicator
- Indicates whether the plan is a Special Needs Plan (SNP), designed to serve people with specific diseases, dual eligibility, or institutional needs.
- Value
- No
- Derived
- false
- SNP Type
- Specifies the type of Special Needs Plan, such as D-SNP for dual-eligible individuals, C-SNP for chronic conditions, or I-SNP for institutional care.
- Value
- Not Applicable
- Derived
- false
- Part D Coverage Indicator
- Indicates whether the Medicare Advantage plan includes Part D prescription drug coverage.
- Value
- No
- Derived
- false
- Drug Benefit Category
- Specifies whether the plan’s drug benefit is defined as basic, enhanced, or other CMS-classified categories.
- Value
- Not Applicable
- Derived
- false
- Drug Benefit Type
- Specifies the delivery structure of the plan’s drug benefit, such as defined standard, actuarially equivalent, or enhanced alternative.
- Value
- Not Applicable
- Derived
- false
- Voluntary De Minimis
- Indicates whether the plan participates in the voluntary de minimis policy, allowing small premium differences without disqualifying LIS benchmark eligibility.
- Value
- No
- Derived
- false
- Part D Basic Premium Benchmark
- The CMS-calculated benchmark for basic Part D premiums used to determine Low-Income Subsidy (LIS) eligibility thresholds.
- Value
- Not Applicable
- Derived
- false
- LIS Auto-Enrollment Eligible
- Indicates whether the plan is eligible for automatic enrollment of Low-Income Subsidy (LIS) beneficiaries by CMS.
- Value
- Not Applicable
- Derived
- false
- Drug Tiers with No Deductible
- Indicates which drug tiers are excluded from the plan’s Part D deductible, allowing members to access medications without paying the deductible first.
- Value
- Not Applicable
- Derived
- false
- Part D Deductible
- The annual amount a member must pay out of pocket for Part D drugs before the plan begins to pay.
- Value
- Not Applicable
- Derived
- false
- Part D Basic Premium
- The portion of the plan's monthly premium that covers the standard Part D drug benefit.
- Value
- Not Applicable
- Derived
- false
- Part D Supplemental Premium
- The monthly premium amount for any supplemental drug coverage offered beyond the standard Part D benefit.
- Value
- Not Applicable
- Derived
- false
- Part D Total Premium
- The total monthly premium for the Part D plan, including both the basic and any supplemental components.
- Value
- Not Applicable
- Derived
- true
- Low Income Premium Subsidy (LIPS) Amount
- The amount of monthly premium subsidized by CMS for Low-Income Subsidy (LIS) eligible members enrolled in the plan.
- Value
- 32.71
- Derived
- false
- Part D LIPS (CMS Pays)
- The total amount CMS pays on behalf of LIS-eligible enrollees to cover premium costs under the Low-Income Subsidy program.
- Value
- Not Applicable
- Derived
- false
- Part D Low Income Beneficiary Premium Amount
- The amount that a Low-Income Subsidy (LIS) beneficiary is responsible for paying after CMS premium subsidies have been applied.
- Value
- Not Applicable
- Derived
- true
- Part D Out-of-Pocket (OOP) Threshold
- The total amount a member must spend on covered Part D drugs in a calendar year before entering the catastrophic coverage phase.
- Value
- Not Applicable
- Derived
- false
- Part C Premium
- The monthly premium a member pays for Medicare Advantage (Part C) coverage, excluding prescription drug (Part D) premiums.
- Value
- $155.00
- Derived
- false
- Monthly Consolidated Premium (Part C + D)
- The total monthly premium a member pays for the Medicare Advantage plan, including both Part C and Part D coverage.
- Value
- Not Applicable
- Derived
- true
- In-Network Maximum Out-of-Pocket (MOOP) Amount
- The maximum amount a member will pay out of pocket for in-network Medicare-covered services during the plan year, after which the plan pays 100%.
- Value
- Derived
- false
- Record Checksum
- Checksum value associated with this published plan record.
- Value
- VXQ-731-H8145-163-0
- Derived
- true
- Entity
- contract:H8145
- Digest
- 2026-cms-part-c-and-d-performance
- Source URL
- https://www.medicareplans.com/medicare-advantage/plan/H8145-163-0/
- Glossary Scope
- cms_performance
- Fragment Scope
- semantic-digest
- Method
- https://webmem.com/protocol/serialization/html/
- fragment-H8145-163-0-landscape
- Overall Star Rating
- The overall CMS star rating for the plan, based on quality and performance across all measured domains.
- Value
- 3.5
- Unit
- stars
- Derived
- false
- Staying Healthy Measure
- Includes preventive screenings, vaccines, and wellness checks that help members stay healthy.
- Value
- 3
- Unit
- stars
- Derived
- false
- Managing Chronic Conditions Measure
- Evaluates how effectively the plan helps members manage chronic health conditions like diabetes, COPD, or hypertension.
- Value
- 3
- Unit
- stars
- Derived
- false
- Member Experience Measure (Health Plan)
- Captures what members say about their experience with the health plan.
- Value
- 5
- Unit
- stars
- Derived
- false
- Plan Complaints Measure
- Tracks member complaints and changes in the plan’s performance over time.
- Value
- 3
- Unit
- stars
- Derived
- false
- Health Plan Customer Service Measure
- Measures how well the plan handles member appeals and customer inquiries.
- Value
- 5
- Unit
- stars
- Derived
- false
Humana Gold Choice H8145-163 (PFFS) Medicare Advantage Plan H8145-163 • 2026
Humana Gold Choice H8145-163 is a Medicare Advantage PFFS plan offered by Humana for the 2026 plan year. It uses a Medicare Private Fee-for-Service (PFFS) provider network and comes without prescription drug coverage. CMS Plan ID H8145-163 identifies this plan.
Humana Gold Choice H8145-163 Overview
Plan Overview for
H8145-163-0
|
|
|---|---|
| CMS Plan ID: |
H8145-163-0
|
| Plan Type: | PFFS |
| Plan Year: | 2026 |
| Monthly Premium: |
$0.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $1500.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | See List |
| Enrollment (Nationwide): | 112 beneficiaries |
| Provided By: | Humana |
Plan Availability
Humana Gold Choice H8145-163 (H8145-163-0) is available in the following locations (click to open):
Coverage Overview for Humana Gold Choice H8145-163
With a monthly premium of $0.00, this Private Fee-for-Service Medicare Advantage plan covers Medicare Part A and Part B services and allows access to Medicare-approved providers who agree to the plan’s terms. Referrals are not required, and provider participation is determined at the time services are received.
Primary care visits have a $0 copay | Out-of-network: $0 copay, specialist visits come with a $0 copay | Out-of-network: $0 copay, urgent care services carry a $0 copay, and ambulance transportation is $335 copay | Out-of-network: $335 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $1500.00. After this limit is reached, covered services are fully paid.
This plan is listed by CMS under Plan ID H8145-163. A breakdown of cost sharing is provided below.
Cost-Sharing Overview
Humana Gold Choice H8145-163 includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H8145-163.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $0 copay |
| Specialist: | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$35 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | Not covered |
| Health transportation (non-emergency): | Not covered |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $0-$780 copay | Out-of-network: $0-$780 copay |
| Lab services: | In-network: $0-$20 copay | Out-of-network: $0-$20 copay |
| Outpatient x-rays: | In-network: $0-$100 copay | Out-of-network: $0-$100 copay |
| Diagnostic tests and procedures: | In-network: $0-$105 copay | Out-of-network: $0-$105 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $150 copay |
| Worldwide emergency care: | $150 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $0 per stay | Out-of-network: | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $20 per day for days 1-20 | $218 per day for days 21-100 | Out-of-network: | $20 per day for days 1-20 | $218 per day for days 21-100 | $0 per stay |
| Ground ambulance: | In-network: $335 copay | Out-of-network: $335 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $35 copay | Out-of-network: $40 copay |
| Outpatient group therapy: | In-network: $35 copay | Out-of-network: $40 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $0 per stay | Out-of-network: | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $20-$40 copay | Out-of-network: $20-$40 copay |
| Occupational therapy: | In-network: $20-$40 copay | Out-of-network: $20-$40 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay, 10%-20% coinsurance | Out-of-network: 20% coinsurance |
| Durable medical equipment: | In-network: $0 copay, 20% coinsurance | Out-of-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | 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 |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $0 copay |
| Cleaning: | In-network: $0 copay | Out-of-network: $0 copay |
| Periodontics: | Not covered |
| Endodontics: | Not covered |
| Restorative services: | Not covered |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: $0 copay |
| Prescription hearing aids: | In-network: $699-$999 copay | Out-of-network: $699-$999 copay |
| OTC hearing aids: | Not covered |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | In-network: $0 copay | Out-of-network: $0 copay |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Humana Gold Choice H8145-163 as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Ratings
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
How much does plan H8145-163 cost per month?
For 2026, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.
What is the annual out-of-pocket maximum (MOOP) for this plan?
For 2026, the in-network maximum out-of-pocket is $1500.00. The plan pays 100% of covered in-network services beyond this amount.
How many beneficiaries are enrolled in this plan?
CMS reports 112 beneficiaries enrolled in this plan.
Is there a Part D deductible for this plan?
The Part D deductible is $0.00.
Contact Information for Humana
| Contact Type | Details |
|---|---|
| Website: | Humana Plan Page |
| New Members: | 1-888-873-0686 |
| Existing Members: | 1-800-457-4708 |
| Plan Address: | 101 E Main Street | Louisville, KY 40202 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | September 8, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Humana (official source) | http://www.humana.com/medicare | October 13, 2025 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| AARP.org | The Big Choice: Original Medicare vs. Medicare Advantage | 25 May, 2025 |
| Medicare.gov | Your coverage options | 25 May, 2025 |
MedicarePlans.com is an independent informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Provenance documentation for this data is maintained under the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.