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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 2025, 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 3.5 out of 5 stars in 2025.
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 $6.00. 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 $150.00 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) plan has a $150 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for a standard generic drug, you will pay a $47 copay, and for a preferred brand drug, you will pay 40% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-015 (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. You'll have no copay for many services like primary care, routine hearing and vision exams, and dental services, but you will have copays for services such as specialist visits, hearing exams, and ambulance services. This plan also covers preventive services with no copay for many services, alongside specialized services such as hearing and vision care with set copays or coinsurance. The plan provides coverage for home health services and skilled nursing facilities with a copay, and includes added benefits like acupuncture and over-the-counter items, providing a comprehensive approach to healthcare needs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization and a doctor referral required. For Inpatient Hospital-Acute, you will pay a $275 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric has a $900 copay.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay of $0 to $275, Observation Services have a copay of $275, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services have no copay. Outpatient substance abuse services have a copay that ranges from $0 to $100 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-015 (HMO) plan, but requires prior authorization and a doctor referral. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-015 (HMO) plan. Medicare-covered ground ambulance services have a copay of $315, and air ambulance services have a copay of $1250, with no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H5619-015 (HMO) plan. Emergency Services has a $120 copay, Urgently Needed Services has a $30 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $120 copay.
Primary Care See details
The Humana Gold Plus H5619-015 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services and physical therapy services with a $15 copay, physician specialist services with a $15 copay, mental health specialty services with a $15 copay for individual and group sessions, other health care professional services with a copay between $0 and $15, psychiatric services with a $15 copay for individual and group sessions, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a copay between $0 and $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus H5619-015 (HMO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. However, health education, in-home safety assessments, personal emergency response systems, and several other services are not covered.
Hearing Services See details
Hearing exams have a $15 copay, routine hearing exams have no copay, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, with a copay between $699 and $999, and OTC hearing aids are covered with a maximum benefit of $75 every three months.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$15, and routine eye exams have no copay. Eyewear has no copay, and there is a combined maximum plan benefit coverage amount of $200.00 per year for contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-015 (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, cleaning, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery, all with no copay. Prosthodontics (fixed) has a 30% coinsurance and no copay. However, fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-015 (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, is covered by this plan. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay of up to $50 for diagnostic procedures/tests and no copay for lab services. Radiological services include coverage for diagnostic radiological services with a copay of up to $120, and therapeutic radiological services with a coinsurance of at least 20%. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-015 (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-015 (HMO) offers Cardiac Rehabilitation Services, but the plan does not cover any of the sub-services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H5619-015 (HMO) with prior authorization and a doctor referral required. For days 1-20, the copay is $10 per day, and for days 21-100, the copay is $100 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H5619-015 (HMO) plan covers acupuncture with a $15 copay, and a meal benefit with no copay. Over-the-counter items are covered with a maximum benefit of $75 every three months. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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