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Humana Gold Plus H5619-061 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-061 (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 H5619-061 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-061 (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 H5619-061 (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 H5619-061 (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 H5619-061 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $74.00. 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 $50.00 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 $4150.00 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 H5619-061 (HMO) plan has a $50 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you'll pay $12 or $20 for preferred generic drugs, depending on the pharmacy, and 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-061 (HMO) plan offers comprehensive coverage with a variety of benefits. This plan includes no copay for primary care, outpatient blood services, and preventive services, as well as no copay for eyewear, home health services, and a meal benefit. Copays vary for inpatient hospital stays, outpatient services, emergency services, and other specialized services, so be sure to check the details for specific coverage costs.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $340 copay for days 1-7, and no copay for days 8-90 for acute care and psychiatric services. Additional days for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $0-$340 copay and 20% coinsurance, Observation Services with a $340 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with 20% coinsurance and no copay for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $100 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H5619-061 (HMO), with prior authorization required for all ambulance services. Medicare-covered Ground Ambulance Services have a $315 copay, while Medicare-covered Air Ambulance Services have a $1250 copay; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent 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 H5619-061 (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay, but routine chiropractic care is not covered. Occupational therapy and physical therapy/speech-language pathology services have a $20 copay, and physician specialist services have a $40 copay. Mental health and psychiatric individual and group sessions have no copay, and other health care professionals may have a copay between $0 and $40. Additional telehealth benefits are available with a copay between $0 and $55, and Opioid Treatment Program Services are covered with a coinsurance of 20% and no copay.
Preventive Services See details
Preventive Services include no copay for Medicare-covered services, annual physical exams, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, as well as fitness benefits. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 H5619-061 (HMO) plan. Hearing exams require a $40 copay, but routine hearing exams and fitting/evaluation for hearing aids are not covered, along with all types of prescription hearing aids and OTC hearing aids.
Vision Services See details
Vision services are covered, with eye exams costing between $0 and $40. 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 H5619-061 (HMO) plan covers dental services, with a $1,000 maximum benefit per year. Oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventative dental services have no copay. Restorative services have a $25 copay, and adjunctive general services have no copay. Fluoride treatment, 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 by the Humana Gold Plus H5619-061 (HMO) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, 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 H5619-061 (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 Diagnostic Procedures/Tests with a copay between $0 and $55, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $350, Therapeutic Radiological Services with 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization and a doctor's referral.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-061 (HMO) plan with no copay and no coinsurance, though 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 not in practice. Prior authorization and a doctor's referral are required, but none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H5619-061 (HMO) plan, with prior authorization and a doctor referral required. You will pay a copay of $20 for days 1-20, $214 for days 21-40, and no copay for days 41-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H5619-061 (HMO) plan covers acupuncture with a $40 copay, and a meal benefit with no copay. However, 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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