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Humana Gold Plus H5619-016 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-016 (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 H5619-016 (HMO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
Humana Gold Plus H5619-016 (HMO) is a HMO plan offered by Arcadian Health Plan, Inc. available for the 2026 plan year to people living in San Diego County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-016 (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 H5619-016 (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 H5619-016 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
Health deductible: information not available.
This plan has a $615.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1900.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $1900.00 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:
Sign up for Humana Gold Plus H5619-016 (HMO)
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Drug Coverage
The Humana Gold Plus H5619-016 (HMO) plan features an Enhanced Alternative drug benefit with an annual prescription deductible of $615.00. After meeting this deductible, your costs during the initial coverage phase include a $5.00 copay for Tier 1 preferred generics and a $47.00 copay for Tier 2 standard generics at standard pharmacies. For brand-name and non-preferred drugs, you will pay a coinsurance of 37% for Tier 3 and 25% for Tier 4. After your annual out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for your covered Medicare Part D prescriptions. Furthermore, qualifying for full Extra Help or Low-Income Subsidy (LIS) reduces your Part D premium to no cost.
Additional Benefits
The Humana Gold Plus H5619-016 (HMO) plan offers robust coverage with low out-of-pocket costs for many essential medical services. Members enjoy no copays and no coinsurance for primary care visits, specialist appointments, physical therapy, and home health services. For hospital care, inpatient acute stays require a $150 daily copay for the first five days with no coinsurance, while emergency room visits carry a $150 copay that is waived if admitted. Additionally, this plan provides valuable supplemental benefits including dental, vision, and hearing care. Most dental services are covered with no copay or coinsurance up to a $2,500 annual limit, while routine eye exams and hearing exams also feature no copays. For medical equipment and specialized care, members can expect manageable cost-sharing, such as a 15% coinsurance for durable medical equipment and a 20% coinsurance for dialysis services.
Inpatient Hospital See details
Humana Gold Plus H5619-016 (HMO) partially covers inpatient hospital services with no coinsurance required. Acute care stays require a $150 copay for days 1 to 5 and no copay for days 6 to 999, while psychiatric stays require a $900 copay per stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-016 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $200, observation services carry a $150 copay per stay, and outpatient substance abuse sessions range from a $25 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus H5619-016 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive this care.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-016 (HMO) covers ambulance services with prior authorization, requiring a $335 copay and coinsurance for ground transport, and a 20% coinsurance and copay for air transport. Transportation services are not covered, including travel to plan-approved or any health-related locations.
Emergency Services See details
Humana Gold Plus H5619-016 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-016 (HMO) covers primary care, specialist visits, physical therapy, and occupational therapy with no copay and no coinsurance, while chiropractic services are partially covered since routine care is not covered. Mental health, psychiatric, and opioid treatment services require copays ranging from $25 to $35 with no coinsurance, but podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H5619-016 (HMO) partially covers preventive services, offering annual physical exams, memory fitness, kidney disease education, and glaucoma screenings with no copay and no coinsurance. However, several supplemental services—including health education, weight management, nutritional benefits, and in-home safety assessments—are not covered.
Hearing Services See details
Humana Gold Plus H5619-016 (HMO) covers routine hearing exams, fitting evaluations, and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with a $299 to $599 copay and no coinsurance for up to two devices per year, though inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Humana Gold Plus H5619-016 (HMO) partially covers vision services, offering annual routine eye exams and select eyewear with no copay or coinsurance under a $350 yearly limit. Covered items include contact lenses and complete eyeglasses, but separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-016 (HMO), offering no copay and no coinsurance for most services up to a $2,500 yearly maximum. A 30% coinsurance and no copay apply to fixed and removable prosthodontics, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-016 (HMO) covers home infusion bundled services, requiring prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H5619-016 (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to access this benefit.
Medical Equipment See details
Humana Gold Plus H5619-016 (HMO) covers medical equipment, including durable medical equipment (DME) with a 15% coinsurance and no copay. Prosthetic devices and medical supplies require a 15% to 20% coinsurance with no copay, while diabetic supplies feature a 10% coinsurance with no copay, and diabetic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H5619-016 (HMO) with prior authorization and a doctor referral. Members pay no copay for lab services and outpatient X-rays, a copay of $0 to $100 for diagnostic tests, a copay of up to $300 for diagnostic radiology, and 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Humana Gold Plus H5619-016 (HMO) covers Home Health Services with no copay and no coinsurance. Access to these covered services requires prior authorization and a doctor referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under Humana Gold Plus H5619-016 (HMO), as none of the individual sub-services—including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services—are covered by the plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-016 (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and a doctor referral, though additional days beyond the Medicare-covered limit are not covered. Patients pay no coinsurance, but there is a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
Other Services are partially covered by Humana Gold Plus H5619-016 (HMO), offering acupuncture, over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for meal benefits and acupuncture, which is limited to 20 treatments per year, while Dual Eligible SNPs with Highly Integrated Services are not covered.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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