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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 2025, please refer to our full plan details page.
Humana Gold Plus H5619-016 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in San Diego County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-016 (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. Additionally, this plan comes with a Part B Premium reduction of $5.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1900.00 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 H5619-016 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, for preferred generic drugs, you will pay a $5 copay at preferred pharmacies and a $20 copay at standard mail pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H5619-016 (HMO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a copay, and outpatient services have copays between $0 and $100. Emergency services have copays, while primary care, preventive services, and home health services have no copay. The plan includes hearing, vision, and dental benefits, with no copays for many services. It also covers medical equipment, diagnostic services, and home infusion. Additional benefits include coverage for ambulance services, skilled nursing facilities, and other services like acupuncture, and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $150 copay for days 1-5, and no copay for days 6-90; additional days have no copay. Inpatient Hospital Psychiatric has a $900 copay.
Outpatient Services See details
Outpatient Services, including all Outpatient Hospital Services, are covered under the Humana Gold Plus H5619-016 (HMO) plan. Outpatient Hospital Services have a copay between $0 and $100. Observation Services have a $150 copay per stay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services, including Individual and Group Sessions, have a copay between $25 and $100.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-016 (HMO) plan. This benefit requires prior authorization and a doctor referral, with a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-016 (HMO) plan. Ground ambulance services have a $300 copay, and air ambulance services have 20% coinsurance, while 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. Emergency Services and Worldwide Emergency Coverage have a $135 copay, and Urgently Needed Services have a $25 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation each have a $135 copay.
Primary Care See details
Primary Care, including Primary Care Physician Services, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services, are covered with no copay. Chiropractic Services, Occupational Therapy Services, Mental Health Specialty Services, Psychiatric Services, Opioid Treatment Program Services, and Other Health Care Professional services are covered, but may require a referral and prior authorization. Additional Telehealth Benefits are covered with a copay between $0 and $25. However, Podiatry Services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams with no copay, and other preventive services. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
The Humana Gold Plus H5619-016 (HMO) plan covers hearing exams with no copay, including routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $599 and $899, and OTC hearing aids are covered up to $40 every three months. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Humana Gold Plus H5619-016 (HMO) plan covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay, and the plan covers one routine eye exam and one pair of contact lenses or eyeglasses per year, with a maximum of $150 per year for all eyewear.
Dental Services See details
The Humana Gold Plus H5619-016 (HMO) plan covers dental services, including oral exams, dental X-rays, other diagnostic services, cleaning, and other preventative services with no copay. Restorative services, prosthodontics, and fixed prosthodontics require a 30% coinsurance and no copay, while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Gold Plus H5619-016 (HMO) plan, requiring prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H5619-016 (HMO), including durable medical equipment with 12% coinsurance and prosthetics/medical supplies with 20% coinsurance. Diabetic equipment is also covered, with details on coinsurance and copay for specific services like diabetic supplies and therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests and lab services, are covered. Diagnostic procedures/tests have a copay between $0 and $100, while lab services have no copay. Diagnostic Radiological Services have a copay of at most $200, and Therapeutic Radiological Services have 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 H5619-016 (HMO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered under this plan.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-016 (HMO) plan, with a $0 copay for days 1-20 and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF, as well as non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services includes coverage for acupuncture with no copay, but requires prior authorization and is limited to 20 treatments per year. Over-the-counter items are covered up to $40 every three months and the plan offers a meal benefit with no copay for a chronic illness, but other services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered.
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