In-network
Inpatient hospital
Days 1–6 $295 / day
Days 7–90 $0 / day
Total of listed copays · 6 charged days $1,770
● CMS 2026 plan record
Humana Gold Choice H8145-091 (PFFS)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network20% coinsurance
Air · in-network20% coinsurance
Emergency services
Emergency room
$130 copay
Medical maximum
Maximum out-of-pocket
In-network$6,500
Combined in + out$6,500
Skilled care at home
Home health
In-network$0 copay
Out-of-network35% coinsurance
Monthly cost
Premium & giveback
Part C premium$0 / month
Consolidated C + D$15 / month
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Primary care physician
In: $0 copay · Out: 35% coinsurance
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Specialist
In: $35 copay · Out: 35% coinsurance
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Preventive care
In: $0 copay · Out: $0 copay
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Diagnostic procedures & tests
In: $0–$50 copay + 25% coinsurance · Out: 35% coinsurance
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Laboratory services
In: $0–$50 copay + 25% coinsurance · Out: 35% coinsurance
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X-rays & standard imaging
In: $0–$15 copay + 20%–25% coinsurance · Out: $0 copay + 35% coinsurance
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MRI, CT & PET imaging
In: $35 copay + 20% coinsurance · Out: 35% coinsurance
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Urgent care
In: Cost share not reported · Out: Not separately reported
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Emergency room
In: $130 copay · Out: Not separately reported
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Ground ambulance
In: 20% coinsurance · Out: 20% coinsurance
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Air ambulance
In: 20% coinsurance · Out: 20% coinsurance
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Outpatient hospital
In: $0–$35 copay + 25% coinsurance · Out: $0 copay + 35% coinsurance
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Outpatient surgery / ASC
In: $0 copay + 20% coinsurance · Out: $0 copay + 35% coinsurance
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Home health
In: $0 copay · Out: 35% coinsurance
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Skilled nursing facility
In: Cost share not reported · Out: Not separately reported
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Cardiac & pulmonary rehabilitation
In: $15 copay · Out: 35% coinsurance
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Occupational therapy
In: $15 copay + 20% coinsurance · Out: 35% coinsurance
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Physical & speech therapy
In: $15 copay + 20% coinsurance · Out: 35% coinsurance
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Mental health services
In: $35 copay · Out: 35% coinsurance
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Substance use treatment
In: $35 copay · Out: 35% coinsurance
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Podiatry
In: $35 copay · Out: 35% coinsurance
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Chiropractic
In: $15 copay · Out: 35% coinsurance
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Dental
In: $35 copay · Out: 35% coinsurance
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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-network35% coinsurance
Specialist
In-network$35 copay
Out-of-network35% coinsurance
Preventive care
In-network$0 copay
Out-of-network$0 copay
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-network$0–$50 copay + 25% coinsurance
Out-of-network35% coinsurance
Laboratory services
In-network$0–$50 copay + 25% coinsurance
Out-of-network35% coinsurance
X-rays & standard imaging
In-network$0–$15 copay + 20%–25% coinsurance
Out-of-network$0 copay + 35% coinsurance
MRI, CT & PET imaging
In-network$35 copay + 20% coinsurance
Out-of-network35% coinsurance
Urgent & hospital care6 benefits
Urgent care
In-networkCost share not reported
Out-of-networkNot separately reported
Emergency room
In-network$130 copay
Out-of-networkNot separately reported
Ground ambulance
In-network20% coinsurance
Out-of-network20% coinsurance
Air ambulance
In-network20% coinsurance
Out-of-network20% coinsurance
Outpatient hospital
In-network$0–$35 copay + 25% coinsurance
Out-of-network$0 copay + 35% coinsurance
Outpatient surgery / ASC
In-network$0 copay + 20% coinsurance
Out-of-network$0 copay + 35% coinsurance
Recovery & therapy5 benefits
Home health
In-network$0 copay
Out-of-network35% coinsurance
Skilled nursing facility
In-networkCost share not reported
Out-of-networkNot separately reported
Cardiac & pulmonary rehabilitation
In-network$15 copay
Out-of-network35% coinsurance
Occupational therapy
In-network$15 copay + 20% coinsurance
Out-of-network35% coinsurance
Physical & speech therapy
In-network$15 copay + 20% coinsurance
Out-of-network35% coinsurance
Behavioral health2 benefits
Mental health services
In-network$35 copay
Out-of-network35% coinsurance
Substance use treatment
In-network$35 copay
Out-of-network35% coinsurance
Specialty care2 benefits
Podiatry
In-network$35 copay
Out-of-network35% coinsurance
Chiropractic
In-network$15 copay
Out-of-network35% coinsurance
Supplemental benefits7 benefits
Dental
In-network$35 copay
Out-of-network35% coinsurance
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$6,500
Combined in + out$6,500
Medical deductibles
In-networkNot reported
Out-of-network$750
Network & referrals
PFFS · Referrals: Not reported · Out-of-network coverage: Yes
Prescription drugs5 tiers
Part D deductible
Not reported
Drug tier 1
$0 retail copay · 30-day supply
Drug tier 2
$5 retail copay · 30-day supply
Drug tier 3
$47 retail copay · 30-day supply
Drug tier 4
50% retail coinsurance · 30-day supply
Drug tier 5
25% retail coinsurance · 30-day supply
Using this plan
Understand H8145-091-000
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 H8145-091 (PFFS) is a 2026 PFFS offered by Humana in Southwest Virginia. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. Its listed inpatient copay stages total $1,770 across 6 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
- $35 copay
- Laboratory services
- $0–$50 copay + 25% coinsurance
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- $0–$50 copay + 25% coinsurance
- MRI, CT & PET imaging
- $35 copay + 20% coinsurance
- Outpatient hospital
- $0–$35 copay + 25% coinsurance
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $130 copay
- Listed inpatient stages
- $1,770 total
6 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
- Southwest Virginia (VA)
- Plan type
- PFFS
- Contract / plan
- H8145-091
- 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$35 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 H8145-091-000 available?
Humana Gold Choice H8145-091 (PFFS) is listed for Southwest 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 H8145-091-000?
The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $6,500. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H8145-091-000?
The listed consolidated Part C and Part D premium is $15 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H8145-091-000?
The plan record lists $130 copay.
Does H8145-091-000 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 H8145-091-000 fits
- Full CMS plan ID
H8145-091-000- Contract
H8145- Base plan code
H8145-091- Segment
000- Carrier
- Humana
- Plan type
- PFFS
- Service area
- Southwest 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.
- Bristol City, VA
- Buchanan, VA
- Dickenson, VA
- Grayson, VA
- Lee, VA
- Russell, VA
- Smyth, VA
- Tazewell, VA
- Washington, VA
- Wise, VA
- Wythe, VA
About this code
What H8145-091-000 identifies
H8145-091-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H8145-091, H8145 091, or the compact full CMS ID H8145091000 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.