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Humana Gold Choice PFFS

Reviewed by Russell Noga, Licensed Medicare Insurance Broker (all 50 states) | Last updated October 8, 2026

Humana Gold Choice is the name Humana has used for its Private Fee-for-Service (PFFS) Medicare Advantage plans, which let you see any Medicare-approved provider who agrees to the plan’s payment terms. We found no verified 2027 change for Gold Choice specifically; confirm whether it is offered in your county.

PFFS plans are less common than HMOs and PPOs. The key difference is that a provider can choose, visit by visit, whether to accept the plan’s terms, unless the provider is in the plan’s network. Humana is cutting 37 PPOs and leaving 57 counties for 2027, so check your area.

See Humana Medicare Advantage plans 2027.

✔ Licensed across all 50 states
✔ Built on CMS 2027 data
✔ No-cost plan comparison

Key Highlights

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PFFS: providers who accept plan terms.

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Providers can decline visit by visit.

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Referrals generally not required.

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Confirm 2027 availability.

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PFFS vs HMO vs PPO

Feature PFFS HMO PPO
Network May or may not have one Required Preferred network
Who you can see Providers who agree to the plan’s terms In-network providers In or out of network
Referrals Generally not required Often required Generally not required
Provider can decline Yes, visit by visit, unless in network Not applicable Not applicable
Drug coverage Some plans include it; others allow a separate Part D plan Usually included Usually included

How to Use a PFFS Plan

Step by Step

1

Show your Humana card at every visit. Tell the office you have a PFFS plan, not Original Medicare.

2

Ask before each visit. Confirm the provider will accept the plan’s terms for that visit.

3

Check for a network. Some PFFS plans have network providers who must treat you.

4

Know the emergency rule. Emergency care is covered even if the provider has not agreed in advance.

5

Review drug coverage. If the plan has no drug coverage, you can generally add a separate Part D plan.

Humana Gold Choice PFFS, What is Humana Gold Choice PFFS?

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Who a PFFS Plan May Fit

May Fit

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Rural areas with few HMOs or PPOs

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People who want no referrals

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People whose doctors accept the plan’s terms

May Not Fit

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People whose doctors decline PFFS plans

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People who want guaranteed access to a network

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Frequent travelers who need certainty

Humana 2027 Changes

Humana 2027 Change Detail
Total plans 861 (down from 887)
PPO plans cut 37
Counties losing plans 57
State exit Minnesota
Members whose plans end About 600,000

Source: Humana and CMS 2027 landscape data reported by Becker’s, October 1, 2026.

How Medicare Advantage Works

Medicare Advantage, sometimes called Part C, lets you receive your Medicare benefits through a Medicare-approved private insurer. These plans cover everything Original Medicare Part A and Part B cover, with the exception of hospice care, which Original Medicare continues to pay for. Most also bundle Part D drug coverage, and many may tack on extras like routine dental, vision and hearing benefits.

The trade-off is that Medicare Advantage plans generally rely on doctor and hospital networks and may call for referrals or prior authorization for certain services. Each Medicare Advantage plan sets a yearly out-of-pocket maximum for covered medical care, something Original Medicare lacks. You still pay your Part B premium, along with the plan’s premium if there is one.

Feature HMO PPO
Out-of-network care Not covered except emergencies and urgent care Covered at a higher cost
Referrals for specialists Usually required Usually not required
Premiums Usually lower Usually higher
Out-of-pocket maximum In-network limit In-network limit plus a higher combined limit
Best for Lower costs, local care Flexibility, travel, keeping specific doctors

Humana Gold Choice PFFS,Key Features of Humana Gold Choice PFFS

If Your Plan Is Ending

A non-renewal notice should have reached you in early October if your plan won’t be available in your county for 2027. Coverage doesn’t end immediately; it runs through December 31, 2026, which gives you time to decide.

If Your Plan Is Ending

1

Review your non-renewal letter. It verifies that your plan is ending and lays out your choices.

2

Write down your doctors and drugs. Comparing replacement plans requires them.

3

Compare your 2027 plan choices. Look at networks, drug coverage and the out-of-pocket maximum, not only the premium.

4

Pick a plan by December 31 to avoid a gap. If you enroll during Annual Enrollment by December 7, your coverage starts January 1, 2027.

5

Rely on your Special Enrollment Period if necessary. If your plan is ending, you generally have until the end of February 2027 to make a choice.

If you take no action: on January 1, 2027, you go back to Original Medicare, and you will have no drug coverage unless you pick a Part D plan. Being without drug coverage may result in a late enrollment penalty.

Medigap rights: if your Medicare Advantage plan exits your area, you generally get a guaranteed issue right, lasting up to 63 days after your coverage ends, to purchase certain Medicare Supplement plans with no health questions.

How to Compare

How to Compare

1

Review your Annual Notice of Change. It spells out every 2027 change to the plan you have now.

2

Verify your doctors and hospitals. Make sure every provider is in the 2027 network, not only the 2026 network.

3

Review your prescriptions. Verify every drug, the tier it falls on and any step therapy or prior authorization rules.

4

Look at the full annual cost. Total up the premium, usual copays and drug costs, and review the out-of-pocket maximum.

5

Look at star ratings. Medicare scores plans on quality and service using a 1 to 5 star scale.

6

Sign up by December 7. Coverage under your new plan begins January 1, 2027.

Enrollment Periods

Enrollment Period Dates What You Can Do
Annual Enrollment Period October 15 to December 7, 2026 Join, change or drop a Medicare Advantage or Part D plan effective January 1, 2027
Medicare Advantage Open Enrollment January 1 to March 31, 2027 In Medicare Advantage, you can change to another plan or go back to Original Medicare one time
Initial Enrollment Period 7 months around your 65th birthday month Sign up for Medicare and choose your first plan
Special Enrollment Periods Varies Switch plans after events such as a move, a loss of other coverage or your plan exiting your area

Annual Enrollment is when most people make changes. If you like your current plan, no action is needed; it renews on its own. Even so, review your Annual Notice of Change, since networks, premiums, copays and drug lists can all change on January 1.

Reading Your Annual Notice of Change

Check Every Line

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Your 2027 premium and deductible

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Doctor, specialist and hospital stay copays

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The out-of-pocket maximum

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Updates to your formulary, drug tiers and coverage rules

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Whether your doctors, hospitals and pharmacy stay in network

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Updates to dental, vision, hearing and other extras

The Annual Notice of Change must reach members by September 30. It is the most useful single document you receive each fall, since it spells out exactly how your plan will change on January 1.

Special Enrollment Periods

Outside of the fall and early-year windows, changing plans generally requires a Special Enrollment Period. Typical reasons include:

You May Qualify If

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Your plan is leaving your area or ending

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You move outside your plan’s service area

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You lose employer or union coverage

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Your Medicaid status changes, or you qualify for a Medicare Savings Program or Extra Help

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You want to join a 5-star plan, once a year

Every Special Enrollment Period has a separate time limit, so move as soon as the event occurs.

Prior Authorization and Referrals

Prior authorization is required by most Medicare Advantage plans for certain services, including some surgeries, advanced imaging, skilled nursing stays and some drugs. While your doctor usually submits the request, ask whether a scheduled service needs approval so you are not caught off guard by a denial.

You or your doctor can appeal a denied request. Medicare rules give plans deadlines for decisions, and those deadlines are shorter when a wait could seriously harm your health.

Emergency, Urgent and Out-of-Area Care

Emergency and urgent care are covered by every Medicare Advantage plan anywhere in the U.S., whether in or out of network, and an emergency does not require prior approval. Routine care while traveling is different: HMOs generally do not cover it, and PPOs cover out-of-network care at a higher cost.

If you’re away from home for months each year, ask every plan how it covers care where you stay. This is among the most frequent reasons people change plans partway through the year.

Appeals and Complaints

You have the right to appeal if your plan denies a service, a drug or payment for care. The denial notice from the plan explains the process. Appeals have several levels, beginning with the plan and moving on to independent reviewers.

If your issue isn’t about coverage, such as wait times or customer service, you can file a grievance with your plan. For help, you can also reach out to 1-800-MEDICARE or your State Health Insurance Assistance Program.

The 2027 Part B Premium

Of the major figures, only the Part B premium is not published alongside the plans. CMS typically announces it in November. Projections in the 2026 Medicare Trustees Report put the 2027 standard premium at about $209.50 a month and the deductible at about $292, up from $202.90 and $283 in 2026. You continue paying it even with Medicare Advantage.

If You Miss December 7

Miss the Annual Enrollment deadline and your current plan automatically renews for 2027, including the changes listed in your Annual Notice of Change. Medicare Advantage members get one more opportunity, from January 1 to March 31, 2027, to change Medicare Advantage plans or go back to Original Medicare and join a Part D plan.

Telehealth

Many Medicare Advantage plans may cover telehealth for some services, at times with a lower copay than an in-person office visit. It is handy for follow-ups and minor problems, but you still need to confirm that your regular doctors are in network.

Pros and Cons of Medicare Advantage

Advantages

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Often a low or $0 premium

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A yearly out-of-pocket maximum

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Drug coverage usually included

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Dental, vision and hearing benefits may be included in many plans

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One card and one plan

Tradeoffs

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Networks; except for emergencies, HMOs require in-network care

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Prior authorization and referrals are common

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Copays add up if you use a lot of care

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Plans and networks can change every year

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Moving to Medigap later may involve health questions

Special Needs Plans

Special Needs Plans (SNPs) are Medicare Advantage plans designed for particular groups. Their benefits, networks and drug lists are shaped around the members they serve, and many come with care coordinators. In 2027, SNPs are one of the few places large insurers are adding plans, even while cutting PPOs.

Type Who Qualifies What Is Different
Dual Special Needs Plan (D-SNP) People with both Medicare and Medicaid Coordinates both programs; costs are often very low, with extra benefits
Chronic Condition SNP (C-SNP) People who have qualifying conditions like diabetes, heart failure or chronic lung disease Doctors, drugs and programs designed around the condition
Institutional SNP (I-SNP) People who live in a nursing home or need that level of care at home Care delivered where the member lives

Turning 65 in 2027

When you turn 65 in 2027, you get a seven-month Initial Enrollment Period: the three months before your birthday month, the birthday month itself and the three months that follow. If you sign up in the first three months, coverage begins on the first day of your birthday month.

Turning 65 Checklist

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Enroll in Part A and Part B, unless you have qualifying employer coverage and decide to postpone Part B

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Choose between Medicare Advantage and Original Medicare plus Medigap

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Enroll in a drug plan, or a Medicare Advantage plan that includes drugs, to avoid a late Part D penalty

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If you go with Medigap, purchase during your six-month Medigap Open Enrollment Period

Getting Help

You do not need to compare plans by yourself, and help should not cost you anything. Here are the free options:

Free Help Comparing Plans

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Available any time: Medicare Plan Finder on Medicare.gov

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1-800-MEDICARE (1-800-633-4227), reachable 24 hours a day on all seven days of the week

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Your State Health Insurance Assistance Program (SHIP), which provides free, unbiased counseling

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A licensed agent or insurance broker, who can compare plans across several insurers for free

Gather your Medicare card, a list of your drugs and doses, your doctors and your preferred pharmacies before you call. That way a long conversation becomes a quick one.

Bottom Line

The Bottom Line

Humana Gold Choice PFFS can offer flexibility without referrals, but providers can decline it. Confirm 2027 availability in your county and ask your doctors whether they accept the plan.

Compare plans and enroll online

Frequently Asked Questions

➤ What is Humana Gold Choice PFFS?

Humana Gold Choice is the name Humana has used for its Private Fee-for-Service Medicare Advantage plans. They let you see Medicare-approved providers who agree to the plan’s payment terms. Confirm whether Gold Choice is offered in your county for 2027.

➤ How does a PFFS plan work?

The plan sets how much it pays providers and what you pay. A provider who is not in the plan’s network can decide, visit by visit, whether to accept those terms. If they accept, they must follow the plan’s rules for that visit.

➤ Can a doctor refuse my PFFS plan?

Yes. Unless the doctor is in the plan’s network, they can choose not to accept the PFFS plan’s terms for a visit. Ask before each appointment. Emergency care is covered even if the provider has not agreed in advance.

➤ Do PFFS plans require referrals?

Generally no. PFFS plans usually do not require referrals to see specialists. You still need the specialist to accept the plan’s terms for that visit, so call the office ahead of time and confirm before you go.

➤ Does Humana Gold Choice include drug coverage?

Some PFFS plans include Part D drug coverage and others do not. If your PFFS plan has no drug coverage, you can generally buy a separate Part D plan. For 2027 the Part D deductible can be up to $700 and the out-of-pocket cap is $2,400.

➤ Is Humana Gold Choice available for 2027?

We found no verified 2027 information on Gold Choice availability. Humana is leaving Minnesota and 57 counties and cutting 37 PPOs, so enter your ZIP code to see whether a Humana PFFS plan is offered in your county.

➤ Is a PFFS plan better than an HMO or PPO?

Not always. PFFS can offer flexibility where networks are thin, but providers can decline it. HMOs usually cost less with in-network rules, and PPOs give a set network plus out-of-network coverage. Compare total cost and access.

➤ What if my Humana PFFS plan is ending?

If you received a non-renewal letter, coverage continues through December 31, 2026. You get a Special Enrollment Period and generally a guaranteed issue right to buy certain Medigap plans until 63 days after coverage ends.

➤ When can I enroll in a Humana PFFS plan?

Annual Enrollment runs October 15 to December 7, 2026, for coverage starting January 1, 2027. Medicare Advantage members can also make one change from January 1 to March 31, 2027, if a Humana PFFS plan does not suit them.

Have Questions?

Speak with a licensed insurance agent

1-833-641-4938

TTY users 711

Mon-Fri: 8am-9pm ET

Find & Compare Plans Online

Speak with a licensed insurance agent

1-833-641-4938TTY 711

Mon-Fri: 8am-9pm ET

ZRN Health & Financial Services, LLC, a Texas limited liability company

( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.