Medicare Advantage Plan Without Prescription Drugs
Network Type
PFFS
Humana Gold Choice H8145-126 (PFFS) is a Medicare Advantage Plan Without Prescription Drugs, which is available in Missouri and offered by the health insurance company Humana. This plan’s network type is PFFS which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Monthly Premium
$0
Annual Deductible
$0
Max Out-of-Pocket
$6,700 In and Out-of-network
Primary doctor visit
$5 copay per visit
Specialist visit
$40 copay per visit
ER visit
$90 copay per visit (always covered)
Ambulance
$265 copay
Humana Gold Choice H8145-126 (PFFS) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $6,700 In and Out-of-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Humana Gold Choice H8145-126 (PFFS) are defined below.
Additional Benefits and Coverage
No
Part D Prescription Drug Coverage
Yes
Dental
Yes
Vision
Yes
Hearing
Humana Gold Choice H8145-126 (PFFS) is a Medicare Advantage plan which does not include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Humana Gold Choice H8145-126 (PFFS) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Humana Gold Choice H8145-126 (PFFS) includes coverage for the following additional benefits:
Other benefits
Fitness benefit
Not covered
Over the counter drug benefits
Limited coverage
In-home support services
Not covered
Home and bathroom safety devices
Not covered
Meals for short duration
Limited coverage
Annual physical exams
Limited coverage
Telehealth
Limited coverage
Comparing the Quality Score of Humana Gold Choice (PFFS) to Other Plans in Missouri
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2025, Humana Gold Choice (PFFS) received an overall government quality rating of 4.0 stars out of 5 stars.
Humana Gold Choice (PFFS) performed better than Missouri’s State average overall quality score of 3.8 stars.
This Plan’s 5-star Gov’t Quality Score
Missouri State Average Score
Overall Government 5 Star Quality Rating
4.0
3.8
Summary rating of health plan quality
4
3.8
Staying healthy: screenings, tests, & vaccines
3
3.7
Managing chronic (long term) conditions
3
3.5
Member experience with health plan
5
3.8
Member complaints & changes in the health plan's performance
4
3.8
Health plan customer service
4
4.0
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Humana Gold Choice (PFFS) received 4 stars for its health plan quality score which is better than the Missouri State average health plan quality score of 3.8 stars.
In-network: $5 copay per visit
Out-of-network: $20 copay per visit
Specialist visit
In-network: $40 copay per visit
Out-of-network: $50 copay per visit
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0-55 copay
Out-of-network: $20-50 copay or 30% coinsurance
Lab services
In-network: $0-55 copay
Out-of-network: $20-50 copay or 30% coinsurance
Diagnostic radiology services (like MRI)
In-network: $40-250 copay or 20% coinsurance
Out-of-network: $50 copay or 30% coinsurance
Outpatient x-rays
In-network: $5-55 copay
Out-of-network: $20-50 copay or 30% coinsurance
Emergency care
$90 copay per visit (always covered)
Urgent care
$55 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $360 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 91 and beyond
Out-of-network: $360 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
In-network: $45-360 copay per visit
Out-of-network: $50 copay or 30% coinsurance per visit
Skilled nursing facility
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$172 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$172 per day for days 21 through 100
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: $0 copay or 50% coinsurance
Ambulance
Ground ambulance
In-network: $265 copay
Out-of-network: $265 copay
Therapy services
Occupational therapy visit
In-network: $25 copay
Out-of-network: $50 copay or 30% coinsurance
Physical therapy & speech & language therapy visit
In-network: $25 copay
Out-of-network: $50 copay or 30% coinsurance
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $30 copay
Out-of-network: $50 copay
Outpatient individual therapy with a psychiatrist
In-network: $30 copay
Out-of-network: $50 copay
Outpatient group therapy visit
In-network: $30 copay
Out-of-network: $50 copay
Outpatient individual therapy visit
In-network: $30 copay
Out-of-network: $50 copay
Opioid treatment services
Opioid treatment services
Covered
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: 50% coinsurance per item
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
Diabetes supplies
In-network: $0 copay or 10-20% coinsurance per item
Out-of-network: 20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
In this article we rank Missouri Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.
The Medicare landscape in Missouri is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in Missouri.
Health Plan Radar