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Humana Gold Plus H5619-026 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-026 (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 H5619-026 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-026 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in San Joaquin County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-026 (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 H5619-026 (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 H5619-026 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $88.00. 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 a $615.00 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 $6750.00 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 H5619-026 (HMO) plan features an enhanced alternative drug benefit with a prescription drug deductible of $615.00. During the initial coverage phase, preferred generic drugs require a $5.00 copay at standard pharmacies and through preferred mail delivery, while standard generics have a $47.00 copay. For brand-name and non-preferred medications, you will pay a 44% coinsurance for preferred brand drugs and a 25% coinsurance for non-preferred drugs. If you qualify for the low-income subsidy, your Part D costs are reduced to no cost. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D prescriptions.
Additional Benefits
The Humana Gold Plus H5619-026 (HMO) plan offers affordable routine care, featuring no copays and no coinsurance for primary care doctor visits, annual physicals, preventive screenings, and routine dental cleanings. Routine eye and hearing exams, home health services, and home-delivered meals are also covered with no copay. Basic Medicare-covered dental and vision services are highly accessible, requiring a minimal $10 copay with no coinsurance. For major medical needs, inpatient hospital stays require a $350 copay for the first seven days and no copay for additional days, while emergency room visits carry a $130 copay. Outpatient hospital services, diagnostic radiology, and ground ambulance services require copays up to $350 with no coinsurance. Specialized services such as dialysis, durable medical equipment, and select Part B drugs require coinsurance ranging from 10% to 20% with no copays.
Inpatient Hospital See details
Humana Gold Plus H5619-026 (HMO) partially covers inpatient hospital services, with acute stays requiring a $350 copay for days 1-7 and no copay for days 8 through 999, with no coinsurance. Inpatient psychiatric care requires a $900 copay per stay with no coinsurance. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H5619-026 (HMO) with no coinsurance and no copay for ambulatory surgical center and blood services. Copays for other services range from $25 to $35 for outpatient substance abuse sessions, and up to $350 for outpatient hospital and observation services.
Partial Hospitalization See details
Humana Gold Plus H5619-026 (HMO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Humana Gold Plus H5619-026 (HMO), as transportation services to plan-approved or any health-related locations are not covered. Ground ambulance services require a $335 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for both.
Emergency Services See details
Humana Gold Plus H5619-026 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Humana Gold Plus H5619-026 (HMO), as podiatry services and routine chiropractic care are not covered. Covered services require no coinsurance, with copayments ranging from no copay for primary care physician visits up to $50 for telehealth services.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H5619-026 (HMO), offering annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. However, additional services such as fitness benefits, weight management, health education, and in-home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus H5619-026 (HMO) partially covers hearing services with no deductible or coinsurance, offering routine exams and fitting evaluations for no copay, and Medicare-covered exams for a $10 copay. Up to two prescription hearing aids are covered per year with a $699 to $999 copay, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-026 (HMO) covers eye exams with a $0 to $10 copay and no coinsurance, including one annual routine exam with no copay. Eyewear is partially covered with no copay or coinsurance up to a $100 annual limit for contact lenses and complete eyeglasses, though separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-026 (HMO) partially covers dental services, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $10 copay and no coinsurance, while preventive care such as exams, cleanings, and x-rays features no copay and no coinsurance. Additional procedures like endodontics and periodontics are available as optional supplemental benefits for an extra cost.
Home Infusion bundled Services See details
Humana Gold Plus H5619-026 (HMO) covers home infusion bundled services with prior authorization, including Medicare Part B insulin drugs for a $35 copay and no coinsurance. Chemotherapy, radiation, and other covered Part B drugs require no copay and feature a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
Humana Gold Plus H5619-026 (HMO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H5619-026 (HMO) covers medical equipment with prior authorization, featuring a 15% coinsurance and no copay for durable medical equipment. Diabetic supplies require a 10% coinsurance and no copay, therapeutic shoes or inserts require a $10 copay and no coinsurance, and prosthetic devices and medical supplies require a 20% and 15% coinsurance, respectively, with no copays.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H5619-026 (HMO), requiring a doctor referral and prior authorization. Lab services and outpatient X-rays have no copay or coinsurance, diagnostic procedures and tests range from a $0 to $50 copay with no coinsurance, diagnostic radiological services cost up to a $300 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Humana Gold Plus H5619-026 (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
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H5619-026 (HMO) plan, which offers no coverage, copays, or coinsurance for cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Humana Gold Plus H5619-026 (HMO), requiring prior authorization and a doctor referral. There is a $10 copay for days 1 to 20, a $218 copay for days 21 to 100, and no coinsurance, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under the Humana Gold Plus H5619-026 (HMO) plan, as over-the-counter items and dual eligible SNPs are not covered. Covered acupuncture services require a $10 copay and no coinsurance, while the covered meal benefit is offered with no copay and no coinsurance.
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