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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 2026, 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 out of 5 stars in 2026.
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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $410.00 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 features an Enhanced Alternative drug benefit with no prescription drug deductible. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies or through preferred mail order, while Tier 2 standard generics carry a $47 copay. For Tier 3 preferred brands and Tier 4 non-preferred drugs, you will pay a 50% and 33% coinsurance, respectively. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Medicare Part D prescriptions. This plan also offers premium reductions down to $0.00 for individuals who qualify for the low-income subsidy.
Additional Benefits
The Humana Gold Plus H5619-021 (HMO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, acute inpatient hospital stays, and routine home health services. Emergency room visits require a $150 copay, which is waived if you are admitted within 24 hours, while urgent care visits carry a $65 copay. Outpatient services and partial hospitalization are also highly affordable, featuring maximum copays of $35 and no coinsurance. In addition to medical care, this plan provides valuable dental, vision, and hearing benefits, including a $3,000 annual dental limit and no copay for routine eye exams. Prescription hearing aids require a copay of $99 to $399, while durable medical equipment and dialysis require coinsurance ranging from 15% to 20% with no copay. Members also enjoy no copay for acupuncture, over-the-counter items, and up to 24 one-way trips to plan-approved locations.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Gold Plus H5619-021 (HMO), with Medicare-covered acute stays requiring no copay and no coinsurance, while psychiatric stays incur a $410 copay per stay and no coinsurance. Both services require prior authorization and referrals, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H5619-021 (HMO) with no coinsurance and copays ranging from no copay for ambulatory surgical center, observation, and blood services up to $35 for outpatient hospital and substance abuse sessions. Prior authorization and doctor referrals are required for most of these covered services.
Partial Hospitalization See details
Humana Gold Plus H5619-021 (HMO) covers partial hospitalization benefits with a $35 copay and no coinsurance. These covered services require a doctor referral and prior authorization.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-021 (HMO) covers ambulance services with no coinsurance and a copay of $335 for ground transport and $1,250 for air transport. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H5619-021 (HMO) with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require 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
Primary care benefits are partially covered under Humana Gold Plus H5619-021 (HMO) with no copay or coinsurance for doctor, specialist, therapy, and chiropractic visits, though podiatry services are not covered. Mental health, psychiatric, and opioid treatment services require copays ranging from $25 to $35, while telehealth services range from no copay up to a $65 copay with no coinsurance.
Preventive Services See details
Humana Gold Plus H5619-021 (HMO) partially covers preventive services with no copay or coinsurance for covered benefits like annual physical exams, kidney disease education, and memory fitness. However, several supplemental services are not covered, including health education, weight management, alternative therapies, therapeutic massage, and in-home support.
Hearing Services See details
Humana Gold Plus H5619-021 (HMO) covers hearing services with no copay or coinsurance for exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with a $99 to $399 copay and no coinsurance, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-021 (HMO) offers partially covered vision services with no copay or coinsurance, including one routine eye exam and a combined $450 annual limit for contact lenses and eyeglasses (lenses and frames). Under this plan, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-021 (HMO) up to a $3,000 annual maximum, featuring no copays or coinsurance for most covered services, while fixed and removable prosthodontics require a 30% coinsurance and no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Gold Plus H5619-021 (HMO), requiring prior authorization and potentially step therapy. For covered services, Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H5619-021 (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
Medical equipment is covered by Humana Gold Plus H5619-021 (HMO), including durable medical equipment (DME) which requires a 15% coinsurance and no copay. Prosthetic devices require a 20% coinsurance, medical supplies require a 15% coinsurance, and diabetic supplies have a 10% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with a $10 copay, and prior authorization is required for these benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-021 (HMO) covers diagnostic and radiological services, requiring a doctor referral and prior authorization. Diagnostic tests range from no copay to a $65 copay with no coinsurance, therapeutic radiology requires a 20% coinsurance with no copay, and lab work, diagnostic radiology, and outpatient X-rays are covered with no copays or coinsurance.
Home Health Services See details
Humana Gold Plus H5619-021 (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 H5619-021 (HMO) indicates that some services are covered, but Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Because these services are not covered in practice, there are no copay or coinsurance benefits available for them.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-021 (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization and a doctor referral are required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-021 (HMO) offers partially covered Other Services with no copay and no coinsurance for acupuncture, over-the-counter items, and meal benefits. Dual Eligible SNPs with Highly Integrated Services are not covered.
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