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Humana Gold Plus H5619-021 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-021 (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 H5619-021 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-021 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Los Angeles and Orange 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 H5619-021 (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 H5619-021 (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 H5619-021 (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 $2.00. 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 $675.00 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 H5619-021 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, for a standard pharmacy, you'll pay no copay for preferred generic drugs, a $42 copay for standard generic drugs, and 40% coinsurance for preferred brand drugs. 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 H5619-021 (HMO) plan offers comprehensive coverage with no copays for many services, including inpatient hospital stays, outpatient services, and primary care visits. The plan also includes additional benefits like dental, vision, and hearing services, with no copays for many services, as well as coverage for ambulance, emergency, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the Humana Gold Plus H5619-021 (HMO) plan. Inpatient Hospital-Acute has no copay for a Medicare-covered stay, and the plan covers additional days with no copay; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric has a $600 copay for a Medicare-covered stay, but additional days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $10, observation services with no copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $10 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H5619-021 (HMO) plan, with no copay required and prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including all ambulance services and transportation services to plan-approved health-related locations. Ground ambulance services have a $200 copay, while air ambulance services have a $1250 copay, and transportation services have no copay. 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 under the Humana Gold Plus H5619-021 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Urgently Needed Services have no copay; all services have no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-021 (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy and speech-language pathology services, and other health care professional services have no copay, while mental health and psychiatric services have a $10 copay for both individual and group sessions, and additional telehealth benefits have a copay between $0 and $10. Routine chiropractic care is limited to 12 visits per year.
Preventive Services See details
Preventive services include Medicare-covered services and additional preventive services, with no copay for an annual physical exam. Additional preventive services include Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay, while other services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing services include hearing exams with no copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $399 and $699 for all types, while OTC hearing aids are covered up to $60 every three months.
Vision Services See details
The Humana Gold Plus H5619-021 (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 (lenses and frames) per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-021 (HMO) plan covers a variety of dental services. Medicare Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Oral and Maxillofacial Surgery are covered with no copay. Prosthodontics, removable and Prosthodontics, fixed services have a 30% coinsurance and no copay. Fluoride Treatment, Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a maximum benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-021 (HMO) plan. This plan requires prior authorization and a doctor referral, and has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with an 18% coinsurance, and Prosthetics/Medical Supplies with a 20% coinsurance. Diabetic Equipment is also covered, with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests and Lab Services have no copay, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-021 (HMO) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus H5619-021 (HMO) plan. Prior authorization and a doctor's referral are required for the services, but none of the listed services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $50.
Other Services See details
Other services include acupuncture with no copay, but requires prior authorization and is limited to 20 treatments per year. Over-the-counter items are covered with a $60 maximum benefit every three months, and the plan offers nicotine replacement therapy and naloxone coverage. The plan also offers a meal benefit with no copay, and the meals are for chronic illnesses.
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