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Humana Gold Plus H5619-059 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-059 (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 H5619-059 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-059 (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 H5619-059 (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 H5619-059 (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 H5619-059 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $54.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $100.00 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 $3400.00 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 H5619-059 (HMO) plan features a low $100 drug deductible and highly affordable options for generic medications. You will pay no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through preferred mail order. For Tier 2 generic drugs, copays start at $5 for a one-month supply, with no copay required for a three-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply across standard pharmacies and mail-order options, with preferred mail order reducing three-month supply costs to $131. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring 31% coinsurance. These structured pharmacy and mail-order options help you manage your prescription costs effectively under this HMO plan.
Additional Benefits
The Humana Gold Plus H5619-059 (HMO) plan offers affordable medical coverage with no copay and no coinsurance for primary care visits, preventive services, annual physical exams, and routine dental, vision, and hearing screenings. When specialized care is needed, members pay a $40 copay for specialist visits and a $35 copay for physical, occupational, and speech therapies. Emergency room visits carry a $150 copay, while urgently needed services require a $55 copay, both with no coinsurance. For inpatient hospital stays, there is a $350 daily copay for the first 7 days and no copay for days 8 through 90. The plan also provides up to $1,000 in annual dental coverage and a $100 annual allowance for eyewear with no copays. Durable medical equipment, prosthetics, and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H5619-059 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 to 7 and no copay for days 8 to 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-059 (HMO) covers outpatient hospital services with no coinsurance and a copay ranging from $0 to $360, plus a $350 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse sessions have no coinsurance and a copay of $0 to $35.
Partial Hospitalization See details
Humana Gold Plus H5619-059 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by Humana Gold Plus H5619-059 (HMO) with prior authorization and no coinsurance, requiring a $335 copay for ground transport and a $1,250 copay for air transport, while transportation services are not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H5619-059 (HMO) with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $55 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-059 (HMO) covers primary care physician services and mental health specialty sessions with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapies are covered with a $35 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H5619-059 (HMO) covers preventive services—including annual physical exams, kidney disease education, and select screenings—with no copay and no coinsurance. This benefit is partially covered, as a memory fitness program is included with no copay, but other supplemental services like health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Humana Gold Plus H5619-059 (HMO) partially covers hearing services, offering routine exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $40 copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and copays between $699 and $999, but OTC hearing aids as well as inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-059 (HMO) vision services are partially covered with no deductible and no coinsurance. Covered benefits include one routine eye exam per year and one pair of contact lenses or eyeglasses (lenses and frames) per year up to a $100 limit with no copay, while other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-059 (HMO) provides partially covered dental services with an annual maximum of $1,000, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered preventive and comprehensive care. While exams, cleanings, and restorative care are included, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-059 (HMO) covers home infusion bundled services with no copay, although prior authorization and step therapy may be required. Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance to 20%, while covered Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H5619-059 (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H5619-059 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copayment. Diabetic supplies feature a 10% to 20% coinsurance and no copayment, while diabetic therapeutic shoes and inserts require a $10 copayment.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-059 (HMO) covers diagnostic and radiological services, with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests have a copay of $0 to $55 with no coinsurance, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Humana Gold Plus H5619-059 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-059 (HMO) covers cardiac rehabilitation services with no copay and no coinsurance, although prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H5619-059 (HMO) with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 35, and no copay for days 36 to 100. Prior authorization is required and no prior three-day hospital stay is needed, though additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Humana Gold Plus H5619-059 (HMO) provides partial coverage for other services, featuring acupuncture for a $40 copay and no coinsurance up to 20 treatments per year and a chronic illness meal benefit with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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