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Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in California. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP).
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 SNP-DE H5619-038 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.20. 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 $590.00 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 $9350.00 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 SNP-DE H5619-038 (HMO D-SNP) plan has a $590.00 deductible for prescription drugs. Once you meet your deductible, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2000.00. If you qualify for the low-income subsidy, your monthly premium for Part D is $10.20. After your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with coinsurance, and emergency services with a copay. It also covers preventive services, hearing, vision, and dental services, often with no copay or with coinsurance. Additionally, the plan includes coverage for home health services with no copay, skilled nursing facility stays with a copay, and other services like acupuncture and an OTC items benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with a $1,500 copay per admission or stay, and Inpatient Hospital Psychiatric with a $1,200 copay per admission or stay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered by this plan. Outpatient Hospital Services and Observation Services have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services have a 20% coinsurance. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, but requires prior authorization and a doctor referral. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) plan. All ambulance services are covered with no copay and a 20% coinsurance for both ground and air ambulance services. 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, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay. Urgently Needed Services has a 20% coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) plan covers primary care physician services with a 20% coinsurance. Chiropractic services are covered with a 20% coinsurance, and routine chiropractic care has no copay. Occupational therapy services, physician specialist services, physical therapy, and speech-language pathology services are covered with a 20% coinsurance and require prior authorization and a doctor referral.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and wigs for hair loss related to chemotherapy with no copay. Other services like health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams, prescription hearing aids, and OTC hearing aids. Hearing exams have a coinsurance of at most 20% and a copay for Medicare-covered benefits, while prescription hearing aids have a maximum benefit of $500 per ear, and OTC hearing aids have a $0 copay with a maximum benefit of $500 per ear. Fitting/Evaluation for Hearing Aid and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Contact lenses and eyeglasses (lenses and frames) are covered, with contact lenses having no copay, and eyeglasses (lenses and frames) having no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) plan covers dental services, including oral exams, dental X-Rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Medicare Dental Services are covered with 20% coinsurance. The plan has a maximum benefit of $3,000 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) plan. Medicare Part B Insulin Drugs have a $35 copay, with 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%, with no copay.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has an 18% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies and Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests and Lab Services have a coinsurance of up to 20%, with no copay for Diagnostic Procedures/Tests and no copay for Lab Services. Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of up to 20%, with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) 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 SNP-DE H5619-038 (HMO D-SNP) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor's referral. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) plan covers acupuncture with a 20% coinsurance, and it requires prior authorization. The plan also offers an Over-the-Counter (OTC) items benefit with a maximum benefit of $1200 per year, and a meal benefit with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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