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Humana Gold Plus H5619-047 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-047 (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 H5619-047 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-047 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Northern Virginia. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-047 (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 H5619-047 (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 H5619-047 (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 $1.00. 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 a $350.00 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 $9250.00 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 H5619-047 (HMO) plan features a $350 drug deductible and offers excellent savings on generic medications. For Tier 1 preferred generics, you will pay no copay at standard pharmacies and through preferred mail order. Tier 2 generics are also highly affordable, costing as little as a $5 copay for a one-month supply at standard pharmacies or no copay for a three-month supply via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with a slightly reduced copay of $131 for a three-month supply when using preferred mail order. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 47% coinsurance and Tier 5 specialty drugs requiring 29% coinsurance. These structured costs help you easily plan your healthcare budget and manage your prescription expenses.
Additional Benefits
The Humana Gold Plus H5619-047 (HMO) plan offers affordable healthcare coverage with no copays for primary care visits, routine preventive services, home health care, and laboratory diagnostics. For inpatient hospital stays, members pay a daily copay of $375 for the first few days, with no copay for subsequent days and no coinsurance. Specialist visits require a $35 copay, while emergency care is available with a $115 copay that is waived upon hospital admission. This plan also features robust supplemental benefits, including no copays for routine dental, vision, and hearing services, alongside a $250 annual eyewear allowance and a $1,250 dental maximum. Many outpatient and diagnostic services, such as X-rays and ambulatory surgery, are covered with no copay, while durable medical equipment and dialysis require no copay and a 20% coinsurance. Additionally, members can access over-the-counter items with no copay or coinsurance, ensuring comprehensive everyday health support.
Inpatient Hospital See details
Humana Gold Plus H5619-047 (HMO) covers inpatient hospital services with no coinsurance, featuring a $375 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for subsequent days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-047 (HMO) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $450, while observation services require a $375 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, whereas outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus H5619-047 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-047 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance, requiring prior authorization. Some transportation services are covered, though transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Gold Plus H5619-047 (HMO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are available with a $40 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-047 (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and speech therapy services have a $25 copay with no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H5619-047 (HMO) covers preventive services—including annual physicals, kidney disease education, fitness benefits, and routine screenings—with no copay and no coinsurance. However, additional preventive benefits are only partially covered, as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, safety devices, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H5619-047 (HMO) covers hearing services with no deductible and no coinsurance, offering Medicare-covered exams for a $35 copay, and routine exams, fitting evaluations, and OTC hearing aids with no copay. Prescription hearing aids are partially covered with copays ranging from $199 to $499, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H5619-047 (HMO) with no coinsurance, no deductible, and no copay for routine eye exams and covered eyewear up to a $250 annual limit. Prior authorization is required, and other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-047 (HMO) partially covers dental services up to a $1,250 annual maximum, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H5619-047 (HMO) with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-047 (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus H5619-047 (HMO) covers durable medical equipment, prosthetic devices, and medical supplies with no copayment and 20% coinsurance. Diabetic supplies are covered with no copayment and 10% to 20% coinsurance, while diabetic therapeutic shoes or inserts require a $10 copayment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H5619-047 (HMO) with prior authorization required. Lab services, outpatient X-rays, and diagnostic radiological services feature no copay, while diagnostic procedures and tests have no coinsurance and a copay of up to $120. Therapeutic radiological services require a minimum 20% coinsurance and a copay starting at $35.
Home Health Services See details
Humana Gold Plus H5619-047 (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Humana Gold Plus H5619-047 (HMO) with no coinsurance, although prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H5619-047 (HMO) with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-047 (HMO) partially covers other services, offering acupuncture for up to 20 treatments per year with a $35 copay and no coinsurance, and over-the-counter (OTC) items with no copay and no coinsurance. Meal benefits are not covered under this plan.
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