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Humana Gold Plus H5619-057 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-057 (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 H5619-057 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-057 (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 H5619-057 (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 H5619-057 (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 H5619-057 (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 $2.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5900.00 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 H5619-057 (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $10 copay for preferred generic drugs at a standard or preferred mail pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H5619-057 (HMO) plan offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have a copay, but many services, including primary care visits, outpatient blood services, routine eye exams, and dental services, have no copay. The plan also includes coverage for emergency services, hearing and vision services, and medical equipment. You'll find a range of copays and coinsurance amounts depending on the specific service, so it is important to review the details.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For days 1-5, the copay is $390, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a 20% coinsurance and a copay between $0 and $390, and observation services with a $390 copay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a 20% coinsurance and no copay for individual and group sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-057 (HMO) plan, with an $85 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-057 (HMO) plan. Medicare-covered Ground Ambulance Services have a $315.00 copay, and Medicare-covered Air Ambulance Services have a $1250.00 copay, but there is no coinsurance for either service. 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 under the Humana Gold Plus H5619-057 (HMO) plan. Emergency Services has a $125 copay, while Urgently Needed Services has a $55 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-057 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and routine chiropractic care has a $20 copay for up to 12 visits per year. Occupational therapy services have a $20 copay. Physician specialist services have a $25 copay. Mental health and psychiatric individual and group sessions have no copay. Other health care professional services have a copay between $0 and $25. Physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits have a copay between $0 and $55. Opioid treatment program services have a 20% coinsurance and no copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and additional preventive services, alternative therapies, and fitness benefits. Alternative therapies have a $20 copay per visit up to 25 visits, while fitness benefits have no copay. Other services such as health education, in-home safety assessment, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids are covered up to a maximum of $60 every three months.
Vision Services See details
Vision services include coverage for eye exams and eyewear. Eye exams have a copay between $0 and $25, and routine eye exams have no copay; eyewear has a combined maximum plan benefit coverage of $350 per year, with no copay for contact lenses and eyeglasses (lenses and frames).
Dental Services See details
The Humana Gold Plus H5619-057 (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay, while Medicare dental services have a $25 copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-057 (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus H5619-057 (HMO) plan, including Durable Medical Equipment with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, with a copay for Medicare-covered diagnostic procedures/tests and lab services. Diagnostic Procedures/Tests have a maximum copay of $55.00, while Lab Services have no copay. Radiological services are covered with a copay for Medicare-covered diagnostic and therapeutic radiological services; the copay for Diagnostic Radiological Services can be at most $390.00, and a coinsurance of at least 20% applies to Therapeutic Radiological Services. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-057 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services like 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. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. For days 1-20, the copay is $10, for days 21-50 the copay is $214, and for days 51-100, there is no copay.
Other Services See details
The Humana Gold Plus H5619-057 (HMO) plan covers acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year, as well as Over-the-Counter (OTC) items up to $60 every three months. The plan also covers a meal benefit with no copay and prior authorization. However, 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, 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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