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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 2025, 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 3.5 out of 5 stars in 2025.
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 $65.00. 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 $2900.00 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 has a $100 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, you may pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy, or 50% coinsurance for preferred brand drugs. Once your total yearly drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus H5619-059 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have a mix of copays and coinsurance, with some requiring prior authorization. Emergency and urgent care services have copays, and primary care visits are available with no copay. Preventive, vision, and dental services offer some coverage, often with no copay, while hearing services have a copay for exams. The plan covers home health services with no cost, and skilled nursing facilities have a copay structure. Additional benefits include acupuncture and a meal benefit, and some services like ambulance and partial hospitalization have copays.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-7, and no copay for days 8-90; additional days have no copay. Inpatient Hospital-Psychiatric has a $295 copay for days 1-7, and no copay for days 8-90; additional days are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with a 20% coinsurance and a copay between $0 and $360, observation services with a $295 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with 20% coinsurance and no copay, individual sessions for outpatient substance abuse with 20% coinsurance and no copay, group sessions for outpatient substance abuse with 20% coinsurance and no copay, and outpatient blood services with no copay. Outpatient hospital, observation, and outpatient blood services require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-059 (HMO) plan, but requires prior authorization. You will have a $100 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $315 copay, and air ambulance services have a $1250 copay, with no coinsurance for either. 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. Emergency Services have a $140 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
The Humana Gold Plus H5619-059 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, but routine care is not covered. Occupational therapy services have a $35 copay, while physician specialist services have a $40 copay. Mental health specialty services and psychiatric services have no copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 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 Medicare-covered preventive services, annual physical exams, and additional preventive services. Annual physical exams have no copay. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, have no copay.
Hearing Services See details
Hearing services are partially covered by the Humana Gold Plus H5619-059 (HMO) plan, with a $40 copay for hearing exams, but routine hearing exams, fitting/evaluations 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 include eye exams with a copay between $0 and $40, but routine eye exams are not covered. Eyewear is covered with no copay, but contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-059 (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. However, fluoride treatment, endodontics, 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, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-059 (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 benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with varying copays and coinsurance. Durable Medical Equipment for use outside the home is not covered, and Diabetic Supplies have no copay and between 10% and 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $55, Lab Services with no copay, and Diagnostic Radiological Services with a copay of at most $360. Therapeutic Radiological Services have a coinsurance of at least 20%, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-059 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice as none of the sub-services are 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 H5619-059 (HMO) plan. You will pay a $10 copay for days 1-20, a $214 copay for days 21-35, and no copay for days 36-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services offered by Humana Gold Plus H5619-059 (HMO) include acupuncture, with a $40 copay, and a meal benefit with no copay. 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 are not covered.
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