In-network
Inpatient hospital
Days 1–7 $345 / day
Days 8–90 $0 / day
Total of listed copays · 7 charged days $2,415
● CMS 2026 plan record
Humana Gold Choice H8145-042 (PFFS)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network$335 copay
Air · in-network$335 copay
Emergency services
Emergency room
$115 copay
Medical maximum
Maximum out-of-pocket
In-network$5,900
Combined in + out$5,900
Skilled care at home
Home health
In-network$0 copay
Out-of-network$0 copay
Monthly cost
Premium & giveback
Part C premium$0 / month
Consolidated C + DNot reported
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Primary care physician
In: $0 copay · Out: $0 copay
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Specialist
In: $30 copay · Out: $30 copay
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Preventive care
In: $0 copay · Out: $0 copay
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Diagnostic procedures & tests
In: $0–$120 copay · Out: $0–$120 copay
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Laboratory services
In: $0–$50 copay · Out: $0–$50 copay
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X-rays & standard imaging
In: $0–$335 copay · Out: $0–$335 copay
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MRI, CT & PET imaging
In: $30 copay + 20% coinsurance · Out: $30 copay + 20% coinsurance
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Urgent care
In: Cost share not reported · Out: Not separately reported
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Emergency room
In: $115 copay · Out: Not separately reported
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Ground ambulance
In: $335 copay · Out: $335 copay
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Air ambulance
In: $335 copay · Out: $335 copay
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Outpatient hospital
In: $0–$375 copay · Out: $0–$375 copay
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Outpatient surgery / ASC
In: $0–$300 copay · Out: $0–$300 copay
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Home health
In: $0 copay · Out: $0 copay
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Skilled nursing facility
In: Cost share not reported · Out: Not separately reported
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Cardiac & pulmonary rehabilitation
In: $30 copay · Out: $30 copay
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Occupational therapy
In: $15–$35 copay · Out: $15–$35 copay
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Physical & speech therapy
In: $15–$35 copay · Out: $15–$35 copay
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Mental health services
In: $35 copay · Out: $35 copay
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Substance use treatment
In: $35 copay · Out: $35 copay
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Podiatry
In: $30 copay · Out: $30 copay
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Chiropractic
In: $15 copay · Out: $15 copay
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Dental
In: $30 copay · Out: $30 copay
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Vision
In: $0 copay · Out: $0 copay
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Hearing
In: $0 copay · Out: $0 copay
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Transportation
Not reported in this CMS export
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Fitness & wellness
In: $0 copay · Out: $0 copay
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Over-the-counter allowance
In: $0 copay · Out: $0 copay
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Meals
In: $0 copay · Out: $0 copay
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-network$0 copay
Out-of-network$0 copay
Specialist
In-network$30 copay
Out-of-network$30 copay
Preventive care
In-network$0 copay
Out-of-network$0 copay
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-network$0–$120 copay
Out-of-network$0–$120 copay
Laboratory services
In-network$0–$50 copay
Out-of-network$0–$50 copay
X-rays & standard imaging
In-network$0–$335 copay
Out-of-network$0–$335 copay
MRI, CT & PET imaging
In-network$30 copay + 20% coinsurance
Out-of-network$30 copay + 20% coinsurance
Urgent & hospital care6 benefits
Urgent care
In-networkCost share not reported
Out-of-networkNot separately reported
Emergency room
In-network$115 copay
Out-of-networkNot separately reported
Ground ambulance
In-network$335 copay
Out-of-network$335 copay
Air ambulance
In-network$335 copay
Out-of-network$335 copay
Outpatient hospital
In-network$0–$375 copay
Out-of-network$0–$375 copay
Outpatient surgery / ASC
In-network$0–$300 copay
Out-of-network$0–$300 copay
Recovery & therapy5 benefits
Home health
In-network$0 copay
Out-of-network$0 copay
Skilled nursing facility
In-networkCost share not reported
Out-of-networkNot separately reported
Cardiac & pulmonary rehabilitation
In-network$30 copay
Out-of-network$30 copay
Occupational therapy
In-network$15–$35 copay
Out-of-network$15–$35 copay
Physical & speech therapy
In-network$15–$35 copay
Out-of-network$15–$35 copay
Behavioral health2 benefits
Mental health services
In-network$35 copay
Out-of-network$35 copay
Substance use treatment
In-network$35 copay
Out-of-network$35 copay
Specialty care2 benefits
Podiatry
In-network$30 copay
Out-of-network$30 copay
Chiropractic
In-network$15 copay
Out-of-network$15 copay
Supplemental benefits7 benefits
Dental
In-network$30 copay
Out-of-network$30 copay
Vision
In-network$0 copay
Out-of-network$0 copay
Hearing
In-network$0 copay
Out-of-network$0 copay
Transportation
Not reported in this CMS exportNot reported in this CMS export
Fitness & wellness
In-network$0 copay
Out-of-network$0 copay
Over-the-counter allowance
In-network$0 copay
Out-of-network$0 copay
Meals
In-network$0 copay
Out-of-network$0 copay
Plan costs & rulesCoverage overview
Premium & Part B giveback
$0 Part C premium / month · Part B giveback not separately reported
Maximum out-of-pocket (MOOP)
In-network$5,900
Combined in + out$5,900
Medical deductibles
In-networkNot reported
Out-of-network$150
Network & referrals
PFFS · Referrals: Not reported · Out-of-network coverage: Yes
Prescription drugs0 tiers
Part D deductible
CMS did not publish a supported Part D deductible amount
Using this plan
Understand H8145-042-000
Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.
Plan at a glance
A quick read on this plan
Humana Gold Choice H8145-042 (PFFS) is a 2026 PFFS offered by Humana in Select Counties in Virginia. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. Its listed inpatient copay stages total $2,415 across 7 charged days.
Common benefit costs
What you may pay
These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.
Routine care
- Primary care physician
- $0 copay
- Specialist
- $30 copay
- Laboratory services
- $0–$50 copay
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- $0–$120 copay
- MRI, CT & PET imaging
- $30 copay + 20% coinsurance
- Outpatient hospital
- $0–$375 copay
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $115 copay
- Listed inpatient stages
- $2,415 total
7 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.
Helpful context
Terms worth knowing
Maximum out-of-pocket (MOOP)
This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.
Availability
Who can enroll
- Service area
- Select Counties in Virginia (VA)
- Plan type
- PFFS
- Contract / plan
- H8145-042
- Coverage year
- 2026
Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.
Supplemental coverage
Extra benefits reported
Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.
Dental$30 copay
Vision$0 copay
Hearing$0 copay
Over-the-counter allowance$0 copay
Fitness & wellness$0 copay
Meals$0 copay
Plan-specific answers
Frequently asked questions
Where is H8145-042-000 available?
Humana Gold Choice H8145-042 (PFFS) is listed for Select Counties in Virginia (VA). Enrollment generally requires Medicare eligibility and residence in the plan's service area.
What is the in-network maximum out-of-pocket limit for H8145-042-000?
The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $5,900. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H8145-042-000?
The listed Part C premium is $0 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H8145-042-000?
The plan record lists $115 copay.
Does H8145-042-000 report extra benefits?
Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2026
Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.
Plan context
Where H8145-042-000 fits
- Full CMS plan ID
H8145-042-000- Contract
H8145- Base plan code
H8145-042- Segment
000- Carrier
- Humana
- Plan type
- PFFS
- Service area
- Select Counties in Virginia (VA)
County/service-area foundation
CMS service-area entries
Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.
- Bedford, VA
- Bland, VA
- Botetourt, VA
- Brunswick, VA
- Buckingham, VA
- Carroll, VA
- Chesapeake City, VA
- Chesterfield, VA
- Craig, VA
- Emporia City, VA
- Essex, VA
- Floyd, VA
31 additional service-area entries are retained in the data record.
About this code
What H8145-042-000 identifies
H8145-042-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H8145-042, H8145 042, or the compact full CMS ID H8145042000 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.