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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 2025, 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 3.5 out of 5 stars in 2025.
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 $1.00. 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 $350.00 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:
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Drug Coverage
The Humana Gold Plus H5619-083 (HMO) plan has a $350 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay $12 for preferred generic drugs at a standard or mail-order pharmacy. You will pay 48% coinsurance for preferred brand drugs, and 28% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus H5619-083 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays require a copay, while outpatient services have copays between $0 and $390. You'll find no copays for services like annual physical exams, vision eyewear, and many dental services. This plan also includes coverage for ambulance services with a $300 copay and emergency services with a $100 copay. Primary care visits have a $5 copay, and specialist visits have a $45 copay, with additional benefits like hearing exams, dental services, and medical equipment also covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $390 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has a $587 copay for days 1-3, and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient hospital services have a copay between $0 and $390, while observation services have a $390 copay. Ambulatory Surgical Center services and Outpatient Blood Services have no copay, while outpatient substance abuse services have a copay between $40 and $100 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H5619-083 (HMO) plan, but requires prior authorization. You will have a $55 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H5619-083 (HMO). Ground and air ambulance services have a $300 copay, and transportation services to a plan-approved health-related location have no copay, with a limit of 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H5619-083 (HMO) plan. Emergency Services have a $100 copay and no coinsurance, Urgently Needed Services have a $55 copay and no coinsurance, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $100 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-083 (HMO) plan covers primary care physician services with a $5 copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. The plan covers physician specialist services with a $45 copay, and individual and group mental health and psychiatric sessions with a $40 copay. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay between $0 and $55. Opioid treatment program services are covered, with a copay between $40 and $100, and routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Annual Physical Exams with no copay, and Additional Preventive Services, Kidney Disease Education Services, and Other Preventive Services with a copay. Other Preventive Services include Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit, all with no copay. Health Education, In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, Post-discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefits, 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams have a $45 copay, routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) having a copay between $699 and $999, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are covered, with a maximum amount of $25 every three months.
Vision Services See details
The Humana Gold Plus H5619-083 (HMO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay between $0 and $45, and eyeglasses and contact lenses have no copay, with a combined maximum benefit of $150 per year.
Dental Services See details
The Humana Gold Plus H5619-083 (HMO) plan covers a variety of dental services. Medicare dental services have a $45 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay, and restorative services have a $25 copay; however, fluoride treatment, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, 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 with coinsurance between 0% and 20%. Other Medicare Part B drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-083 (HMO) plan. This benefit has a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus H5619-083 (HMO) plan, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus H5619-083 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $130, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $495, Therapeutic Radiological Services have a copay of at most $45 and coinsurance of at least 20%, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-083 (HMO) plan with no copay and no coinsurance. 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 Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-083 (HMO) plan. There is no copay for days 1-20, and a $203 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H5619-083 (HMO) plan covers acupuncture with a $45 copay, and it is limited to 20 treatments per year. The plan also covers over-the-counter (OTC) items, including nicotine replacement therapy and naloxone, with a maximum benefit of $25 every three months, and it offers a meal benefit with no copay. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services, and the other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and more are not covered.
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