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Humana Gold Plus H5619-015 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-015 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H5619-015 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-015 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Tulare and Kings counties. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-015 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus H5619-015 (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Humana Gold Plus H5619-015 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Gold Plus H5619-015 (HMO) offers an Enhanced Alternative prescription drug benefit with an annual deductible of $615. Individuals who qualify for the low-income subsidy will benefit from no premium costs for Part D. During the initial coverage phase, Tier 1 preferred generic drugs require a $5 copay at standard pharmacies or preferred mail, while Tier 2 standard generic drugs carry a $47 copay. Higher tiers require coinsurance, with Tier 3 preferred brand drugs at 47% coinsurance and Tier 4 non-preferred drugs at 25% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Be sure to check the plan formulary to confirm which specific medications are covered under these tiers.
Additional Benefits
The Humana Gold Plus H5619-015 (HMO) plan offers comprehensive coverage for essential medical services with predictable cost-sharing. Members enjoy no copay for primary care visits, preventive screenings, and home health services, while specialist visits require a low $15 copay. For hospital care, inpatient stays have no coinsurance and require a $275 daily copay for the first six days, and emergency room visits carry a $130 copay which is waived if you are admitted. This plan also features strong supplemental benefits, including no copay or coinsurance for routine dental care up to a $2,000 annual limit and routine vision exams. Prescription hearing aids are covered with copays ranging from $199 to $499, while routine hearing exams and over-the-counter hearing aids require no copay. Additionally, medical equipment like durable medical equipment and diabetic supplies are covered with coinsurance ranging from 10% to 15% and no copay.
Inpatient Hospital See details
Humana Gold Plus H5619-015 (HMO) partially covers inpatient hospital benefits with no coinsurance, requiring a $275 daily copay for days 1-6 (and no copay for days 7-999) for acute care, and a $900 copay per stay for psychiatric care. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-015 (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay ranging from no copay to $275, observation services carry a $275 copay per stay, and outpatient substance abuse sessions cost between $25 and $35 per session.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Gold Plus H5619-015 (HMO) with a $35.00 copay and no coinsurance. These services require both prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Humana Gold Plus H5619-015 (HMO), with Medicare-covered ground ambulance requiring a $335 copay and air ambulance requiring a $1,250 copay, both with no coinsurance. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H5619-015 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-015 (HMO) provides partially covered primary care benefits, with podiatry services and routine chiropractic care not covered by the plan. Covered services feature no coinsurance, with copays ranging from no copay for primary care visits, $15 for specialists and physical therapy, and up to $50 for telehealth services.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H5619-015 (HMO), which offers annual physicals, kidney education, and select screenings with no copay and no coinsurance. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, fitness benefits, disease management, telemonitoring, remote access, bathroom safety devices, and counseling.
Hearing Services See details
Humana Gold Plus H5619-015 (HMO) covers hearing exams with a $15 copay, routine exams and fitting evaluations with no copay, and all exams with no coinsurance. Prescription hearing aids are partially covered with a $199 to $499 copay and no coinsurance, excluding inner ear, outer ear, and over-the-ear models, while over-the-counter hearing aids are covered with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H5619-015 (HMO), offering routine eye exams with no copay and other exams for a $0 to $15 copay, with no coinsurance. Covered eyewear, including contact lenses and eyeglasses, has no copay or coinsurance up to a $300 annual limit, though standalone eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-015 (HMO) partially covers dental services up to a $2,000 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care, a $15 copay and no coinsurance for Medicare dental, and a 30% coinsurance with no copay for fixed prosthodontics. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-015 (HMO) covers home infusion bundled services, including Part B insulin, chemotherapy, and other Part B drugs, subject to prior authorization and step therapy. Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy and other Part B drugs require no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus H5619-015 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H5619-015 (HMO) covers medical equipment, including durable medical equipment (DME) and medical supplies with a 15% coinsurance and no copay, and prosthetic devices with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-015 (HMO) covers diagnostic and radiological services, requiring prior authorization and doctor referrals for these benefits. Lab services and outpatient X-rays have no copay or coinsurance, while diagnostic tests require a $0 to $50 copay (no coinsurance), diagnostic radiology requires a $0 to $300 copay (no coinsurance), and therapeutic radiology requires a 20% coinsurance (no copay).
Home Health Services See details
Humana Gold Plus H5619-015 (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization and a doctor referral are required to access this benefit.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-015 (HMO) states that some services are covered, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered in practice. Because these services are not covered, there are no copayments or coinsurance fees required.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-015 (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization and doctor referrals are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Humana Gold Plus H5619-015 (HMO), which offers acupuncture for a $15 copay and no coinsurance, as well as over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Highly integrated services for dual eligible SNPs are not covered under this plan.
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