Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP)

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 out of 5 stars in 2026.

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.

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.

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:

Drug Coverage

The Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) offers an enhanced alternative drug benefit with a yearly prescription drug deductible of $490. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies and through preferred mail, while Tier 2 standard generics and Tier 3 preferred brands carry a 25% coinsurance. Tier 4 non-preferred drugs require a 27% coinsurance across standard pharmacies and mail-order options. If you qualify for the low-income subsidy, your Part D costs can be reduced to nothing. Furthermore, once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. This plan provides structured and predictable costs to help you manage your prescription expenses.

Additional Benefits

The Humana Gold Plus SNP-DE H5619-038 (HMO D-SNP) plan offers comprehensive medical coverage, featuring no copays and a 20% coinsurance for primary care, specialist visits, outpatient hospital services, and diagnostic tests. Inpatient hospital stays require a copay of $1,500 for acute care or $1,200 for psychiatric care per admission with no coinsurance, while emergency room visits incur a $115 copay that is waived if admitted. Skilled nursing facility care is also covered with no copay or coinsurance for the first 20 days, transitioning to a $218 daily copay for days 21 to 100. For everyday wellness, members benefit from no copay or coinsurance on preventive care, home health services, and over-the-counter items. Dental care is covered up to a $3,000 annual maximum with no copay or coinsurance for most services, while vision benefits offer up to $350 yearly for eyeglasses with no copay or coinsurance. Other essential services like medical equipment, routine hearing exams, and dialysis are covered with no copay and a 20% coinsurance.