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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 2026, 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 out of 5 stars in 2026.
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 $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 $615.00 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 $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 features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, starting with no copay for a 3-month supply filled via preferred mail order or a $5 copay for a 1-month supply at standard pharmacies. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with 3-month supplies ranging from $131 to $141 depending on your choice of pharmacy. For higher-tier medications, Tier 4 non-preferred drugs carry a 50% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance. These structured copayments and coinsurance rates offer clear expectations for your prescription costs under this Humana Medicare Advantage plan.
Additional Benefits
The Humana Gold Plus H5619-057 (HMO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $25 copay, while inpatient hospital stays have a $390 daily copay for the first five days and no copay for subsequent days. Emergency care is available with a $130 copay, which is waived if you are admitted, while urgent care services require a $50 copay. For supplemental care, this plan features no copay and no coinsurance for routine hearing exams, over-the-counter hearing aids, and routine vision care up to a $350 annual limit. Preventive and comprehensive dental services are also covered with no copay up to a $3,000 yearly maximum. Durable medical equipment and dialysis services require no copay but carry a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-057 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $390 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-057 (HMO) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $390, while observation services require a $390 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, and outpatient substance abuse sessions have no coinsurance and a copay between $0 and $35.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus H5619-057 (HMO) plan with a $35 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under Humana Gold Plus H5619-057 (HMO) with no coinsurance, requiring a $335 copay for ground ambulance and a $1,250 copay for air ambulance. While some transportation services are covered, trips to plan-approved or any other health-related locations are not covered in practice.
Emergency Services See details
Humana Gold Plus H5619-057 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services each carry a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-057 (HMO) offers partially covered primary care benefits with no copay and no coinsurance for primary care visits, a $25 copay and no coinsurance for specialists, and a $20 copay and no coinsurance for physical, occupational, and speech therapies. While routine chiropractic visits are covered for a $15 copay and no coinsurance, other chiropractic services and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H5619-057 (HMO) covers preventive services, including annual physicals, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. While memory fitness is covered with no copay and alternative therapies are covered with a $20 copay and no coinsurance, several services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus H5619-057 (HMO) covers routine hearing exams and fitting evaluations with no copay or coinsurance, while Medicare-covered exams require a $25 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $299 to $599 and no coinsurance, though inner ear, outer ear, and over-the-ear types are not covered. Over-the-counter (OTC) hearing aids are fully covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H5619-057 (HMO) partially covers vision services, providing routine eye exams and eyewear like contact lenses or eyeglasses up to a $350 annual limit with no copay and no coinsurance. Other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered, and prior authorization is required for covered services.
Dental Services See details
Humana Gold Plus H5619-057 (HMO) partially covers dental services, offering Medicare-covered dental care for a $25 copay and no coinsurance, and other preventive and comprehensive dental services with no copay or coinsurance up to a $3,000 annual maximum. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the Humana Gold Plus H5619-057 (HMO) plan with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H5619-057 (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Humana Gold Plus H5619-057 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, subject to prior authorization. Diabetic supplies require a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-057 (HMO) covers diagnostic services with no coinsurance, featuring a $0 to $50 copay for diagnostic tests and no copay for lab services. Covered radiological services include outpatient X-rays and diagnostic radiology with no copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H5619-057 (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under the Humana Gold Plus H5619-057 (HMO) plan. Although the benefit technically features no coinsurance, key sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-057 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 50, and no copay for days 51 to 100. Prior authorization is required, a three-day hospital stay is not required prior to admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-057 (HMO) offers other services including acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture, which is limited to 25 treatments per year, and the meal benefits, while certain other supplemental services are not covered.
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