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Humana Gold Plus H5619-083 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-083 (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 H5619-083 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-083 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Charleston Metro Area. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-083 (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 H5619-083 (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 H5619-083 (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.
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 $6700.00 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 H5619-083 (HMO)
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Drug Coverage
The Humana Gold Plus H5619-083 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay at standard pharmacies and through preferred mail order, while standard mail order costs $10 for a one-month supply. Tier 2 generic medications cost a $5 copay for a one-month supply at standard pharmacies and preferred mail order, with no copay required for a three-month supply via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply across standard pharmacies and mail-order options. Higher-tier medications, such as Tier 4 non-preferred drugs, carry a 43% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. This clear tier structure helps you estimate your annual out-of-pocket costs for prescription medications under the Humana Gold Plus H5619-083 (HMO) plan.
Additional Benefits
The Humana Gold Plus H5619-083 (HMO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, mental health services, and routine hearing exams require a $35 copay, while inpatient hospital stays incur a daily copay of $375 for the first several days with no coinsurance. Outpatient services and diagnostic procedures are also highly accessible, featuring no coinsurance and copays ranging from no copay up to $450 depending on the specific service. For supplemental care, this plan provides valuable vision and dental benefits, featuring no copay and no coinsurance up to specified annual limits of $150 and $1,500 respectively. Emergency services require a $130 copay, which is waived upon hospital admission, while urgent care visits have a $50 copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, ensuring affordable support for your ongoing medical needs.
Inpatient Hospital See details
Humana Gold Plus H5619-083 (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1 through 8 of acute stays and days 1 through 6 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-083 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance. Prior authorization is required for these outpatient services.
Partial Hospitalization See details
Humana Gold Plus H5619-083 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-083 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. Although some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Gold Plus H5619-083 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services require a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-083 (HMO) features primary care physician visits with no copay and no coinsurance, while specialist visits and mental health services require a $35 copay and no coinsurance. Physical, occupational, and speech therapy are covered with a $25 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H5619-083 (HMO) covers preventive services, including annual physicals, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, EKGs, and a memory fitness benefit with no copay and no coinsurance. This benefit is partially covered because services such as 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/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H5619-083 (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 a $699 to $999 copay and no coinsurance for up to two aids per year, excluding inner, outer, and over the ear types, while OTC hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H5619-083 (HMO) offers partially covered vision services with no deductible, including one routine eye exam and eyewear (contact lenses or eyeglasses) up to a $150 yearly limit with no copay and no coinsurance. Other eye exams have a copay of up to $35.00 and no coinsurance, while other eye exam services, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-083 (HMO) partially covers dental services up to a $1,500 annual limit, offering no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental requires a $35 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H5619-083 (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs require from no coinsurance up to 20% coinsurance, while Part B insulin drugs require a $35 copay and from no coinsurance up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H5619-083 (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Humana Gold Plus H5619-083 (HMO) covers durable medical equipment (DME), prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and 10% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the Humana Gold Plus H5619-083 (HMO) plan, with prior authorization required. Lab services, diagnostic radiology, and outpatient X-rays feature no copay, while diagnostic procedures range from a $0 to $120 copay with no coinsurance, and therapeutic radiology requires a minimum $45 copay and minimum 20% coinsurance.
Home Health Services See details
Humana Gold Plus H5619-083 (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus H5619-083 (HMO) plan with no coinsurance, subject to prior authorization. While some services are covered, specific sub-services are not covered, including cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation (with a $40 copay), pulmonary rehabilitation (with a $35 copay), and supervised exercise therapy for peripheral artery disease (with a $25 copay).
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-083 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
Humana Gold Plus H5619-083 (HMO) offers partially covered other services, featuring acupuncture for a $35 copay and no coinsurance for up to 20 annual treatments, and chronic illness meal benefits with no copay and no coinsurance, both requiring prior authorization. Over-the-counter items are also covered with no copay and no coinsurance, though some CMS OTC list drugs and other unspecified services are not covered.
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