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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 2026, 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 out of 5 stars in 2026.
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 $63.00. 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 $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 $4200.00 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 features an annual prescription 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 cost as low as a $12 copay for a 1-month supply, with no copay for a 3-month supply when filled via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, which can increase to $141 for a 3-month supply depending on your pharmacy choice. Higher-tier medications, such as Tier 4 non-preferred drugs and Tier 5 specialty drugs, require a 50% coinsurance and a 25% coinsurance respectively. These tier-based costs help you plan your healthcare budget while maximizing savings on daily medications.
Additional Benefits
The Humana Gold Plus H5619-061 (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care, annual physicals, and home health services. For specialized care, members pay a $40 copay for specialists, while inpatient hospital stays require a $340 daily copay for the first 7 days followed by no copay for days 8 through 90. Members also benefit from routine dental, vision, and hearing care with no copay, including up to a $1,000 annual limit for preventive dental services and a $100 allowance for eyewear. Other essential services like diagnostic lab tests feature no copay, while durable medical equipment and dialysis require a 20% coinsurance. Emergency room visits carry a $150 copay, which is waived if you are admitted to the hospital.
Inpatient Hospital See details
Humana Gold Plus H5619-061 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $340 daily copay for days 1 through 7 and no copay for days 8 through 90. While unlimited additional acute care days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H5619-061 (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital and observation services require a copay ranging from no copay to $340, while outpatient substance abuse sessions carry a copay ranging from no copay to $35.
Partial Hospitalization See details
Humana Gold Plus H5619-061 (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
Humana Gold Plus H5619-061 (HMO) covers ambulance services with prior authorization and no coinsurance, requiring a $335 copay for ground services and a $1,250 copay for air services, while transportation services are not covered.
Emergency Services See details
Humana Gold Plus H5619-061 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $55 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-061 (HMO) provides primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapies have a $20 copay and no coinsurance, but podiatry is not covered, and for chiropractic care, some services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered under the Humana Gold Plus H5619-061 (HMO) plan with no copay and no coinsurance for annual physicals, kidney disease education, and memory fitness. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H5619-061 (HMO) with no deductible, featuring a $40 copay and no coinsurance for Medicare-covered exams, alongside routine exams and fitting evaluations at no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999, though inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-061 (HMO) provides partially covered vision services with no coinsurance and no copays, including one routine eye exam and a $100 annual limit for contact lenses or eyeglasses per year. Prior authorization is required, and other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-061 (HMO) features partially covered dental services, with exclusions for fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental has a $40 copay and no coinsurance, restorative services require a $25 copay and no coinsurance, and other preventive dental services are offered with no copay and no coinsurance up to a $1,000 annual limit.
Home Infusion bundled Services See details
Humana Gold Plus H5619-061 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H5619-061 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H5619-061 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with 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 H5619-061 (HMO) covers diagnostic and radiological services, with prior authorization required for all care. Lab services feature no copay and no coinsurance, while diagnostic procedures require a $0 to $55 copay with no coinsurance. Diagnostic radiological services have a copay starting at $0, outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services require a copay and at least 20% coinsurance.
Home Health Services See details
Humana Gold Plus H5619-061 (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required before you can receive these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-061 (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. However, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-061 (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Covered stays require a $20 copay for days 1 to 20, a $218 copay for days 21 to 40, and no copay for days 41 to 100, while days beyond the 100-day limit are not covered.
Other Services See details
Humana Gold Plus H5619-061 (HMO) provides partial coverage for other services, excluding over-the-counter (OTC) items. Covered benefits include acupuncture for a $40.00 copay and no coinsurance (up to 20 treatments per year) and a chronic illness meal benefit with no copay and no coinsurance, both of which require prior authorization.
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