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Humana Gold Plus H5619-071 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-071 (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 H5619-071 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-071 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Kentucky and Indiana. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-071 (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 H5619-071 (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 H5619-071 (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 $250.00 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 $5450.00 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 H5619-071 (HMO) plan features a $250 drug deductible. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. If you use standard mail order for these generic tiers, copays range from $10 to $20 for a one-month supply. For Tier 3 preferred brand drugs, the plan requires a $47 copay for a one-month supply at standard pharmacies and mail order services. Tier 4 non-preferred drugs carry a 47% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply. These clear cost-sharing tiers help you easily estimate your prescription expenses with this Humana HMO plan.
Additional Benefits
The Humana Gold Plus H5619-071 (HMO) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits, annual physicals, and home health services. For inpatient hospital stays, members pay a $530 copay for days one through five, followed by no copay for unlimited additional days. Specialist visits and outpatient mental health services require a $35 copay, while emergency room care carries a $130 copay that is waived if admitted. This plan also includes extensive supplemental benefits, offering routine dental services with no copay up to a $2,500 annual limit and routine eye exams with no copay alongside a $450 annual eyewear allowance. Routine hearing exams and over-the-counter hearing aids are covered with no copay, while prescription hearing aids require copays ranging from $699 to $999. Additionally, members benefit from no copay for up to 24 yearly one-way transportation trips to plan-approved locations and no copay on over-the-counter items.
Inpatient Hospital See details
Humana Gold Plus H5619-071 (HMO) covers inpatient acute hospital stays with no coinsurance and a $530 copayment for days 1 to 5, followed by no copay for unlimited additional days. Inpatient psychiatric care is also covered with no coinsurance and a $530 copayment for days 1 to 4, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-071 (HMO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $520, while outpatient substance abuse sessions require a $35 copay and observation services carry a $530 copay per stay.
Partial Hospitalization See details
Humana Gold Plus H5619-071 (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 H5619-071 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 24 yearly one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under the Humana Gold Plus H5619-071 (HMO) plan are covered with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-071 (HMO) offers primary care physician services with no copay and no coinsurance, while physical, occupational, and speech therapies require a $20 to $30 copay and no coinsurance. Specialist, mental health, psychiatric, and opioid treatment services carry a $35 copay with no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H5619-071 (HMO) covers Medicare-covered preventive services, annual physical exams, kidney disease education, and specific screenings with no copay and no coinsurance. Additional preventive services are partially covered, providing a memory fitness benefit with no copay and no coinsurance, but do not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, bathroom modifications, or counseling.
Hearing Services See details
Humana Gold Plus H5619-071 (HMO) hearing services include Medicare-covered exams for a $35 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999—excluding inner ear, outer ear, and over the ear models—while over-the-counter hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H5619-071 (HMO) covers vision services with no coinsurance, offering one routine eye exam per year with no copay and other exams for a $0 to $35 copay, though other eye exam services are not covered. Eyewear is partially covered with no copay or coinsurance up to a $450 annual limit for one pair of eyeglasses or contact lenses, but individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-071 (HMO), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,500 annual maximum. Sub-services that are not covered under this plan include fluoride treatments, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Humana Gold Plus H5619-071 (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and 0% to 20% coinsurance, while covered Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H5619-071 (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 H5619-071 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Covered diabetic supplies require a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes and inserts have a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-071 (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a copay of $0 to $105 for diagnostic procedures. Radiological services range from outpatient X-rays and diagnostic radiology with no copay, to therapeutic radiology which carries a minimum 20% coinsurance and a minimum $30 copay.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H5619-071 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by the Humana Gold Plus H5619-071 (HMO) plan with no coinsurance, though in practice, major sub-services are not covered. Specifically, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H5619-071 (HMO) with no coinsurance, featuring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, though a prior three-day inpatient hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Humana Gold Plus H5619-071 (HMO) covers acupuncture with a $35 copay and no coinsurance, alongside over-the-counter items and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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