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Humana Gold Plus H5619-056 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-056 (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 H5619-056 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-056 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in WA. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-056 (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 H5619-056 (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 H5619-056 (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 $4.00. 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 $150.00 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 $8000.00 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 H5619-056 (HMO) plan has a $150 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, for a standard generic drug, you will pay a $47 copay, while a preferred brand drug has a 50% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus H5619-056 (HMO) plan offers a variety of benefits with varying costs. This plan covers inpatient hospital stays with a copay, and outpatient services with a copay or coinsurance depending on the service. Emergency services, primary care, and vision services also come with copays, while preventive services and dental services have some services with no copay. Additional benefits include coverage for ambulance services with copays, home health services with no copay, and skilled nursing facility stays with no copay for some days. The plan also covers medical equipment, diagnostic services, and home infusion services, with differing costs depending on the specific service. Dialysis and cardiac rehabilitation services are covered, requiring prior authorization and doctor referrals.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $520 copay for days 1-4 and no copay for days 5-90, and for Inpatient Hospital Psychiatric, you pay a $509 copay for days 1-4 and no copay for days 5-90.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, ambulatory surgical center services, outpatient blood services, and outpatient substance abuse services. Outpatient hospital services have a 20% coinsurance with a copay ranging from $0 to $520, while observation services have a $520 copay. Ambulatory Surgical Center (ASC) Services and outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse have a 20% coinsurance with a copay ranging from $5 to $5.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-056 (HMO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-056 (HMO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $1250 copay, and there is no coinsurance for either service. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by this plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $45 copay, and there is no coinsurance for any of these services.
Primary Care See details
For the Humana Gold Plus H5619-056 (HMO) plan, primary care physician services and chiropractic services have a $15 copay, while occupational therapy services have a $35 copay. Physician specialist services have a $55 copay. Mental health specialty services, including individual and group sessions, have no copay. Physical therapy and speech-language pathology services have a $35 copay. Additional telehealth benefits have a copay ranging from $0 to $55, and Opioid Treatment Program Services have a $5 copay and 20% coinsurance. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services, kidney disease education, and other preventive services. Additional preventive services, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit have no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, 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 are partially covered by the Humana Gold Plus H5619-056 (HMO) plan, with a $55 copay for hearing exams. Routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with a copay between $0 and $55, and eyewear with no copay. However, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-056 (HMO) plan covers Medicare Dental Services with a $55 copay, and covers Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services with no copay. Fluoride Treatment, Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-056 (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
The Humana Gold Plus H5619-056 (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with 4% coinsurance and no copay, and Prosthetics/Medical Supplies with 4% coinsurance and no copay. Diabetic Equipment is covered, with varying coinsurance and copay costs depending on the specific service, including 10-20% coinsurance and no copay for Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient X-ray services are covered. Diagnostic procedures/tests have a copay between $0 and $55, lab services have no copay, diagnostic radiological services have a copay up to $520, and outpatient X-ray services have a $15 copay. Therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-056 (HMO) 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 covered, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-056 (HMO) plan, with a doctor referral and prior authorization required. For days 1-20 and 61-100, there is no copay, and for days 21-60, the copay is $214.
Other Services See details
Under "Other Services," Humana Gold Plus H5619-056 (HMO) covers acupuncture with a $55 copay, and a meal benefit with no copay, but does not cover over-the-counter items, 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, and Self-Directed Personal Assistance Services.
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