Humana Gold Choice H8145-084 (PFFS)

Available to residents of Lamb County, TX for 2026. Contract H8145, plan 084, segment 0.

Renewed, service area reduced for 2026. CMS carries this plan forward from 2025.

Plan details

Monthly premium (Part C + D)	$29.00
— medical (Part C) part	$0.00
— drug (Part D) part	$29.00?
Monthly premium with full Extra Help (LIS)	$24.20?
Part B premium reduction (giveback)	None
Health plan deductible (in-network)	None
In-network out-of-pocket maximum	$6,750.00?
In- and out-of-network out-of-pocket maximum	$6,750.00
Drug deductible	$615.00Tier 1, 2 and 3 exempt
Drug out-of-pocket threshold	$2,100.00
Plan type	PFFS?
Contract / plan	H8145-084-0
Offered by	Humana
Parent organization	Humana Inc.
Formulary drugs	3,359
Formulary exception tier	4?
Pharmacy search	www.humana.com/pharmacy/
Member services	(888)873-0686TTY 711

CMS star ratings

Overall: 3.5 out of 5 stars for Overall
Health plan (Part C): 3.5 out of 5 stars for Health plan (Part C)
Drug plan (Part D): 3 out of 5 stars for Drug plan (Part D)

Published per contract — every plan under contract H8145 shares this rating.

Plan health benefits

Service	In-network	Out-of-network?
Doctor visits
Primary care doctor	$0 copay	$20 copay
Specialist	$40 copay	$50 copay
Other health care professional	$0–$40 copay	$20–$50 copay
Additional telehealth services	$0–$50 copay	—
Preventive care
Medicare-covered preventive services	$0 copay	$0 copay; 50% coinsurance
Annual physical exam	$0 copay	50% coinsurance
Kidney disease education	$0 copay	50% coinsurance
Glaucoma screening	$0 copay	50% coinsurance
Diabetes self-management training	$0 copay	50% coinsurance
Diagnostic tests, labs and imaging
Diagnostic tests and procedures	$0–$50 copay	$20–$50 copay; 30% coinsurance
Lab services	$0–$50 copay	$20–$50 copay; 30% coinsurance
Diagnostic radiology (e.g. MRI, CT)	$0–$360 copay	$0 copay; 30% coinsurance
Therapeutic radiology	$40 copay; 20% coinsurance	30% coinsurance
Outpatient x-rays	$0–$60 copay	$20–$50 copay; 30% coinsurance
Emergency and urgent care
Emergency room	$130 copay	—
Urgent care	$50 copay	—
Worldwide emergency coverage	$130 copay	—
Worldwide urgent care	$130 copay	—
Worldwide emergency transportation	$130 copay	—
Hospital care
Inpatient hospital stay	$350 per day for days 1–5; $0 per day for days 6–90; $0 per day for days 91–999 (additional days)	$350 per day for days 1–5; $0 per day for days 6–90
Outpatient hospital services	$0–$325 copay	$0–$50 copay; 30% coinsurance
Outpatient observation	$350 copay	$350 copay
Ambulatory surgical center	$0–$225 copay	$0 copay; 30% coinsurance
Outpatient blood services	$0 copay	$0 copay
Skilled nursing and home health
Skilled nursing facility	$0 per day for days 1–20; $218 per day for days 21–100	$0 per day for days 1–20; $218 per day for days 21–100
Home health care	$0 copay	50% coinsurance
Kidney dialysis	20% coinsurance	20% coinsurance
Rehabilitation
Occupational therapy	$25 copay	$50 copay; 30% coinsurance
Physical therapy and speech-language therapy	$25 copay	$50 copay; 30% coinsurance
Cardiac rehabilitation	$15–$20 copay	$50 copay; 30% coinsurance
Pulmonary rehabilitation	$15 copay	$50 copay; 30% coinsurance
Mental health and substance use
Inpatient psychiatric hospital stay	$340 per day for days 1–5; $0 per day for days 6–90	$340 per day for days 1–5; $0 per day for days 6–90
Outpatient mental health, individual session	$30 copay	$50 copay
Outpatient mental health, group session	$30 copay	$50 copay
Psychiatrist, individual session	$30 copay	$50 copay
Psychiatrist, group session	$30 copay	$50 copay
Partial hospitalization	$35 copay	30% coinsurance
Intensive outpatient program	$35 copay	30% coinsurance
Outpatient substance use, individual session	$30–$35 copay	$50 copay; 30% coinsurance
Outpatient substance use, group session	$30–$35 copay	$50 copay; 30% coinsurance
Opioid treatment program	$30–$35 copay	$50 copay; 30% coinsurance
Ambulance and transportation
Ground ambulance	$335 copay	$335 copay
Air ambulance	20% coinsurance	20% coinsurance
Transportation to plan-approved locations	Not covered	—
Medical equipment and supplies
Durable medical equipment (e.g. wheelchairs, oxygen)	$0 copay; 20% coinsurance	50% coinsurance
Prosthetics (e.g. braces, artificial limbs)	20% coinsurance	20% coinsurance
Medical supplies	20% coinsurance	20% coinsurance
Diabetes supplies	$0 copay; 10%–20% coinsurance	20% coinsurance
Diabetic therapeutic shoes or inserts	$10 copay	20% coinsurance
Chiropractic, acupuncture and foot care
Chiropractic (Medicare-covered)	$15 copay	$50 copay
Routine chiropractic care	Not covered	—
Acupuncture	$40 copay(limits apply)	$40 copay
Foot exams and treatment (Medicare-covered)	$40 copay	$50 copay
Routine foot care	Not covered	—
Dental?
Medicare-covered dental services	$40 copay	$50 copay
Preventive dental plan limit	$1,000 plan limit every year	—
Oral exams	$0 copay(limits apply)	$0 copay
Cleanings	$0 copay(limits apply)	$0 copay
Fluoride treatment	Not covered	—
Dental x-rays	$0 copay(limits apply)	$0 copay
Other diagnostic dental services	$0 copay(limits apply)	$0 copay
Other preventive dental services	$0 copay(limits apply)	$0 copay
Restorative services (fillings, crowns)	$0 copay(limits apply)	$0 copay
Endodontics (root canals)	$0 copay(limits apply)	$0 copay
Periodontics (gum disease)	$0 copay(limits apply)	$0 copay
Dentures and other removable prosthodontics	Not covered	—
Maxillofacial prosthetics	Not covered	—
Implants	Not covered	—
Bridges and other fixed prosthodontics	$0 copay(limits apply)	$0 copay
Oral and maxillofacial surgery	$0 copay(limits apply)	$0 copay
Orthodontics	Not covered	—
Adjunctive general services	$0 copay(limits apply)	$0 copay
Vision?
Eye exam (Medicare-covered)	$0–$40 copay(limits apply)	$50 copay; 50% coinsurance
Routine eye exam	$0 copay(limits apply)	$0 copay
Eyewear after cataract surgery (Medicare-covered)	$0 copay(limits apply)	30% coinsurance
Eyewear plan limit	$250 plan limit every year	—
Contact lenses	$0 copay(limits apply)	$0 copay
Eyeglasses (frames and lenses)	$0 copay(limits apply)	$0 copay
Eyeglass lenses	Not covered	—
Eyeglass frames	Not covered	—
Eyewear upgrades	Not covered	—
Hearing?
Hearing exam (Medicare-covered)	$40 copay	$50 copay
Routine hearing exam	$0 copay(limits apply)	$0 copay
Hearing aid fitting and evaluation	$0 copay	$0 copay
Hearing aids (all types)	$399–$999 copay(limits apply)	$399–$999 copay
Hearing aids, inner ear	Not covered	—
Hearing aids, outer ear	Not covered	—
Hearing aids, over the ear	Not covered	—
Medicare Part B drugs
Part B insulin	0%–20% coinsurance(step therapy may apply)	20% coinsurance
Chemotherapy and radiation drugs	0%–20% coinsurance(step therapy may apply)	20% coinsurance
Other Part B drugs	0%–20% coinsurance(step therapy may apply)	20% coinsurance
Other extra benefits?
Over-the-counter (OTC) allowance	Covered (allowance not stated)	—
Meals after a hospital stay or for a chronic condition	$0 copay	$0 copay
Fitness benefit	Not covered	—
Health education	Not covered	—
Nutritional / dietary benefit	Not covered	—
Extra smoking and tobacco cessation counseling	Not covered	—
Enhanced disease management	Not covered	—
Telemonitoring	Not covered	—
Remote access technologies (web/phone, nurse line)	Not covered	—
Home and bathroom safety devices	Not covered	—
Counseling services	Not covered	—
In-home safety assessment	Not covered	—
Personal emergency response system (PERS)	Not covered	—
Medical nutrition therapy	Not covered	—
Post-discharge in-home medication reconciliation	Not covered	—
Re-admission prevention	Not covered	—
Wigs for hair loss from chemotherapy	Not covered	—
Weight management programs	Not covered	—
Alternative therapies	Not covered	—
Therapeutic massage	Not covered	—
Adult day health services	Not covered	—
Home-based palliative care	Not covered	—
In-home support services	Not covered	—
Support for caregivers	Not covered	—

In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed; an out-of-network dash means the plan files no separate out-of-network cost for that service. Contact the plan for the full Evidence of Coverage.

Drug tiers — preferred pharmacy, initial coverage

Tier	Cost-sharing
Tier 1	$0.00
Tier 2	$12.00
Tier 3	$47.00
Tier 4	49%
Tier 5	25%

Rx cost-sharing by coverage phase

Tier	30-day supply			90-day supply
Tier	Preferred	Standard	Mail Order	Preferred	Standard	Mail Order
Initial deductible phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$12.00	$12.00	$12.00	$36.00	$36.00	$0.00
Tier 3: Preferred Brand	$47.00	$47.00	$47.00	$141.00	$141.00	$131.00
Initial coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$12.00	$12.00	$12.00	$36.00	$36.00	$0.00
Tier 3: Preferred Brand	$47.00	$47.00	$47.00	$141.00	$141.00	$131.00
Tier 4: Non-Preferred Drug	49%	49%	49%	49%	49%	49%
Tier 5: Specialty Tier	25%	25%	25%	n/a	n/a	n/a
Catastrophic coverage phase
Tier 1: Preferred Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 2: Generic	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 3: Preferred Brand	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 4: Non-Preferred Drug	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00
Tier 5: Specialty Tier	$0.00	$0.00	$0.00	$0.00	$0.00	$0.00

Also available in 53 other TX counties

Benefits in plain text

Humana Gold Choice H8145-084 (PFFS) (H8145-084-0) is a 2026 PFFS Medicare Advantage plan offered by Humana, available to residents of Lamb County, TX.

The monthly premium is $29.00 (Part C and Part D together).

With full Extra Help (the Low-Income Subsidy), the total monthly premium is $24.20.

There is no in-network deductible for health services.

Its in-network out-of-pocket maximum is $6,750.00.

The combined in- and out-of-network out-of-pocket maximum is $6,750.00.

The drug deductible is $615.00. Tier 1, 2 and 3 exempt.

The plan's formulary lists 3,359 drugs.

At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $12.00; tier 3: $47.00; tier 4: 49%; tier 5: 25%.

CMS gives the plan's contract (H8145) an overall rating of 3.5 out of 5 stars.

Email a copy of the plan benefit details

Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.