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Medicare Advantage
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Pennsylvania
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Berks County
 » 
Humana Gold Choice H8145-055

Humana Gold Choice H8145-055 Berks County, PA — 2021 Medicare Advantage Plan

This page contains information about Humana Gold Choice H8145-055 which serves Berks County, Pennsylvania residents only. This is a Medicare Advantage PFFS plan that replaces traditional Medicare benefits (Part A and Part B).
If you need assistance, call us at 1-855-266-4865
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This page contains editorial content that is not endorsed or approved by Humana[2]. This is not a solicitation of insurance.

Contact the Plan
Medicare Rating:
☆☆☆☆☆
CMS Plan ID:H8145-055
CMS Plan Year:2021
Premium:$7.00/mo
Premium Valid:Until 2021-12-31
Drug Plan:No
Rx Deductible:$0.00/year
Online Pharmacy:No
Rx Gap Coverage:
Availability:Berks County, PA
Policy Valid:2021-1-1 to 2021-12-31
Insured By:Humana

Humana Gold Choice H8145-055
2021 Copays in Berks County, PA

Healthcare ServiceMember Cost
Primary Care Doctor:$15 co-pay
Mental Health Specialist (individual):$40 co-pay
Mental Health Specialist (group):$40 co-pay
Chiropractic Services as a supplemental benefit:None
Occupational Therapy Specialist:$20-40 co-pay
Podiatrist Services (Medicare Covered):None
Telehealth Services:$0-45 co-pay
Emergency Room Care:$90 co-pay
Urgent Care:$15-45 co-pay
Ambulance Services:$270 co-pay
Hospital Inpatient Stay:$390 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Outpatient Lab Services:$0-40 co-pay
Outpatient Diag Services:$0-105 co-pay
Routine Eye Exams:Covered
(limited coverage, optional coverage)
Eye Glasses:Upgrades: Yes
Contact lenses: Yes
Eyeglasses (lenses & frames): No
Eyeglass lenses: No
Eyeglass frames: No
Limits Apply
Optional coverage
Hearing Exams:Not Covered
Hearing Aids:Not Covered

Humana Gold Choice H8145-055
Prescription Copays in Berks County, PA

TierPreferredStandard
This plan does not include prescription drug coverage. You can get prescription coverage by joining one of the Medicare Part D Plans in Pennsylvania

Humana Gold Choice H8145-055
CMS 5-Star Review Ratings

CMS MeasureStar Rating
2021 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 PlanNot enough data available
Drug Safety and Accuracy of Drug Pricing☆☆☆☆☆
People commonly ask, "Is Humana Gold Choice H8145-055 any good?" In this table we show you the quality ratings. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0.

Humana Gold Choice H8145-055 2021 Medicare Advantage PFFS Plan for Berks County, PA

Humana Gold Choice H8145-055 is a Medicare Advantage plan, from Humana, that's available to Medicare beneficiaries living in Berks County, Pennsylvania. This is a Private Fee-for-Service (PFFS) health plan option. It does not include a prescription drug plan.

PFFS plans appear similar to Original Medicare and Medigap, but they are slightly different. Specifically, the plan determines how much it will pay doctors, other health care providers, and hospitals, and how much you must pay when you use healthcare services. You can use any physician or specialist you like, so long as they agree to the plan's payment terms.

These are the areas of the plan that are important to compare and review:

  • Premium: This is the amount you will pay monthly, above and beyond your Medicare Part B.
  • Maximum-Out-Of-Pocket (MOOP): This is the most you will pay for co-pays and co-insurance before the plan pays 100%.
  • CMS Ratings: Important measurements across 5 different areas that will help you understand how well this plan will care for you.
  • Prescription Coverage: Not included with this plan.
  • Co-pays & Co-insurance: If you see the doctor regularly, including specialists, you need to know what you'll pay for each visit.

IMPORTANT: A PFFS plan may sound like Original Medicare with Medicare Supplement insurance, but it's not the same. The biggest difference is that your healthcare providers can continue to treat you so long as they accept the terms and conditions of payment. They can also choose not to treat you, unless it's an emergency, if they don't accept the payment terms. Check with your primary care doctor and specialists before you enroll.

NOTE: Humana Gold Choice H8145-055 does not include a drug plan for prescription coverage. To get it, you can add one of the stand-alone Medicare Drug Plans in Pennsylvania.

Monthly Premium

The monthly premium if you join Humana Gold Choice H8145-055 is $7.00 per month. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventative care mandated by CMS (see H8145-055 Summary of Benefits below).

IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.

Maximum Out-of-Pocket (MOOP) Limit

Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The Humana Gold Choice H8145-055 plan MOOP is $- . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.

Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.

NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.

CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medicare Supplement in Berks County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.

Contact Humana

For more information about this plan, and other plans on this site, call 1-855-266-4865. You may also contact the plan:

Prospective Members:(800)833-2364
TTY Users:(711)-
Plan Website:http://www.humana.com/medicare
Formulay Information:Humana Formulary Page
Pharmacy Information:Humana Pharmacy Page

For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov. To learn more about this plan, visit the Humana Medicare website.

Compare Plan Options

The average Pennsylvania senior compares three or more plan options before making an enrollment decision.

Additional Medicare Plan Options in Berks County

Are you eligible for a Berks County, PA Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:

  • Gateway Health Medicare Assured Diamond (Local HMO), for Dual-Eligible beneficiaries
  • UPMC for Life Complete Care (Local HMO), for Dual-Eligible beneficiaries
  • Allwell Dual Medicare (Local HMO), for Dual-Eligible beneficiaries
  • Aetna Medicare Advantra Cares (Local HMO), for Dual-Eligible beneficiaries
  • Gateway Health Medicare Assured Ruby (Local HMO), for Dual-Eligible beneficiaries

Not qualified for an SNP? Here are some additional plans you might consider:

  • Geisinger Gold Classic Advantage (HMO)
  • Geisinger Gold Classic Advantage Rx (HMO)
  • HumanaChoice H5525-038 (PPO)
  • Aetna Medicare Advantra Premier (HMO)
  • BlueJourney Premier (HMO)

RELATED: Top 9 Advantages and Disadvantages of Medicare Advantage Plans

The Medicare Part C information on this page originates from CMS Landscape Source Files, is maintained by David Bynon, and was last updated on October 15, 2020.

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