A non-government entity
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 2025, 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 3.5 out of 5 stars in 2025.
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 $5500.00 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:
Sign up for Humana Gold Plus H5619-071 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H5619-071 (HMO) plan has a $250 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, in the initial coverage phase, you'll pay $5 for preferred generic drugs at a standard or preferred mail pharmacy, and $20 at a standard mail pharmacy. The plan also offers an enhanced alternative drug benefit.
Additional Benefits
The Humana Gold Plus H5619-071 (HMO) plan offers a range of benefits with varying cost-sharing. The plan covers inpatient hospital stays with a copay, outpatient services with copays, and includes no copay for ambulance transportation to a health-related location. Primary care visits have no copay, while specialist visits have a $35 copay, and preventive services are also covered with no copay. This plan also offers coverage for hearing, vision, and dental services, with some services having a copay. Additionally, it covers services such as emergency care, diagnostic and radiological services, and home health services with varying copays and coinsurance. Overall, this plan has a wide range of benefits, with different cost-sharing amounts for each service.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $530 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a copay of $530 for days 1-4 and no copay for days 5-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Humana Gold Plus H5619-071 (HMO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $395, observation services with a $530 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $35 and $80 for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for many of these services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H5619-071 (HMO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $315 copay, while transportation services to a plan-approved health-related location have no copay, with a limit of 24 one-way trips per year via taxi, bus/subway, or medical transport. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including urgently needed and worldwide emergency services, are covered by the Humana Gold Plus H5619-071 (HMO) plan. Emergency services have a $125 copay, urgently needed services have a $55 copay, and worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation each have a $125 copay.
Primary Care See details
The Humana Gold Plus H5619-071 (HMO) plan covers primary care services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a copay between $20 and $30. This plan also covers physician specialist services with a $35 copay, mental health and psychiatric services with a $35 copay, and physical therapy and speech-language pathology services with a copay between $20 and $30. Additionally, this plan offers additional telehealth benefits with a copay between $0 and $55 and opioid treatment program services with a copay between $35 and $80.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Additional preventive services, including Fitness Benefit, Kidney Disease Education Services, and Other Preventive Services, are covered with no copay for specific services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, prescription hearing aids with a copay between $699 and $999, and OTC hearing aids with a maximum benefit of $25 every three months. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
The Humana Gold Plus H5619-071 (HMO) plan covers vision services, including eye exams with a copay of $0-$35, and eyewear with a $0 copay, including contact lenses, and eyeglasses (lenses and frames) with a combined maximum of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $35 copay, and Other Dental Services with a maximum benefit of $1500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay, while fluoride treatment and orthodontics are not covered. Other services such as restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery have no copay, while prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Gold Plus H5619-071 (HMO) plan, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and prior authorization required, Prosthetics/Medical Supplies with coinsurance for covered devices and supplies, and Diabetic Equipment. Diabetic Supplies have a coinsurance between 10% and 20% with no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services, are covered by the Humana Gold Plus H5619-071 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $105, Lab Services have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a copay of up to $720, while Therapeutic Radiological Services have a copay of up to $30 and a coinsurance of at least 20%.
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, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus H5619-071 (HMO) plan, but the specific copay information is not provided in the snippet. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H5619-071 (HMO), but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H5619-071 (HMO) plan covers acupuncture with a $35 copay, up to 20 treatments per year. Over-the-counter items are covered with a maximum benefit of $25 every three months, and meal benefits are covered with no copay. The plan does not cover 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, or Self-Directed Personal Assistance Services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved