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Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP).
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 SNP-DE H5619-082 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.20. 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 $590.00 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 $9350.00 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 SNP-DE H5619-082 (HMO D-SNP) plan has a $590 deductible for prescription drugs. This plan's premium is $38.20 per month if you qualify for the low-income subsidy. During the initial coverage phase, you will pay for your drugs, but the specific costs for each drug tier are not provided in this summary. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services, including substance abuse and ambulatory surgical centers, have a 20% coinsurance. Emergency services have a copay, and primary care, mental health, and physical therapy services have a 20% coinsurance. Preventive services and fitness benefits have no copay, and hearing exams, vision exams, and dental services are covered with no or low copays. The plan also includes coverage for home health, home infusion, and dialysis services, with varying coinsurance amounts. Additionally, the plan provides coverage for medical equipment, diagnostic services, and cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. The plan has a copay of $2185 per admission or stay for Inpatient Hospital-Acute and $2036 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute has no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital and observation services have a 20% coinsurance, while outpatient blood services have no copay. Individual and group sessions for outpatient substance abuse, as well as ambulatory surgical center services, have a coinsurance of 20%.
Partial Hospitalization See details
Partial hospitalization is covered with a 20% coinsurance, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $315 copay, and there is no coinsurance. 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 and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has a 20% coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) plan covers primary care physician services with 20% coinsurance, chiropractic services with no copay, occupational therapy with 20% coinsurance, and physician specialist services with 20% coinsurance. Mental health specialty services, psychiatric services, and opioid treatment program services are covered with a 20% coinsurance. Additional telehealth benefits are covered with 20% coinsurance and no copay, and physical therapy and speech-language pathology services are covered with 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, while additional preventive services, kidney disease education services, and other preventive services are covered, with a copay that varies depending on the service. The plan also covers the Fitness Benefit, with no copay. 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams and prescription hearing aids are covered, while OTC hearing aids are not. Routine hearing exams have no copay and a 20% coinsurance, and fitting/evaluation for hearing aids has no copay and no coinsurance.
Vision Services See details
Vision services include eye exams with no copay and 20% coinsurance, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, with a combined maximum benefit of $550 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $2,000 maximum benefit each year. Medicare Dental Services have a 20% coinsurance after prior authorization, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery have no copay. Fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics, fixed, 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 a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) plan, but prior authorization is required. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance, while Diabetic Supplies and Therapeutic Shoes/Inserts have a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) plan. Diagnostic Procedures/Tests have a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of at most $325 and a coinsurance of at most 20%, and Outpatient X-Ray Services have a $50 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and coinsurance applies.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus SNP-DE H5619-082 (HMO D-SNP) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. 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 SNP-DE H5619-082 (HMO D-SNP) plan covers acupuncture with a 20% coinsurance, but requires prior authorization and is limited to 20 treatments per year. Over-the-counter (OTC) items are covered up to $2100 per year, and the plan offers a meal benefit with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, and the other services are not covered: 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.
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