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Humana Gold Plus H5619-089 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-089 (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 H5619-089 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-089 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Alabama. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-089 (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 H5619-089 (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 H5619-089 (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 $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 $6750.00 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 H5619-089 (HMO) plan features a yearly prescription drug deductible of $615.00 before coverage begins. During the initial coverage phase, copays for Tier 1 preferred generics start at $5.00, while Tier 2 standard generics require a $47.00 copay. For higher-tier prescriptions, you will pay a coinsurance of 48% for Tier 3 preferred brands and 25% for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy will benefit from no premium costs for their Part D coverage.
Additional Benefits
The Humana Gold Plus H5619-089 (HMO) plan offers affordable access to essential medical care, featuring no copay for primary care doctor visits and a $30 copay for specialists. If you require hospital services, inpatient stays carry a $295 daily copay for days 1 through 8 with no copay thereafter, while emergency room visits require a $130 copay. Outpatient hospital services are also cost-effective, with copays ranging from no copay to $235 and no coinsurance. This plan also includes strong coverage for routine wellness, providing dental, vision, and hearing benefits with no copay for most preventive services. Vision exams and eyewear are covered up to a $300 annual limit with no copay, while preventive dental services have no copay up to a $1,750 yearly limit. Additionally, home health services and skilled nursing facility stays for the first 20 days are available with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-089 (HMO) covers inpatient acute hospital stays with a $295 daily copay for days 1 through 8 and no copay for days 9 and beyond, with no coinsurance. Inpatient psychiatric care is covered with a $272 daily copay for days 1 through 8 and no copay for days 9 through 90, though upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H5619-089 (HMO) with no coinsurance, featuring copays ranging from $0 to $235 for outpatient hospital services, $295 per stay for observation services, and $35 for substance abuse sessions. Ambulatory surgical center and blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Gold Plus H5619-089 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-089 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. While 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 H5619-089 (HMO) covers emergency services 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 under a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits are covered by Humana Gold Plus H5619-089 (HMO) with no copay and no coinsurance for primary care physician visits. Specialist visits require a $30 copay, occupational and physical therapies require a $20 copay, and mental health services require a $35 copay with no coinsurance, though podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the Humana Gold Plus H5619-089 (HMO) plan, offering covered benefits like annual physical exams, fitness benefits, and glaucoma screenings with no copay and no coinsurance. Many supplemental services are not covered, including health education, weight management, in-home safety assessments, and nutritional counseling.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus H5619-089 (HMO), offering Medicare-covered exams for a $30 copay, routine exams and fitting evaluations for no copay, and no coinsurance. Prescription hearing aids are covered with a copay of $0 to $299 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Humana Gold Plus H5619-089 (HMO), offering routine eye exams and covered eyewear with no copay and no coinsurance, while other eye exams have a copay of $0 to $30. Covered eyewear includes contact lenses and combined eyeglasses (lenses and frames) up to a $300 annual limit, but separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-089 (HMO) dental benefits are partially covered up to a $1,750 annual limit, with a $30 copay and no coinsurance for Medicare-covered dental services. Most covered preventive, diagnostic, and comprehensive services have no copay and no coinsurance, though restorative and prosthodontic services require a 30% to 40% coinsurance and no copay. Fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H5619-089 (HMO), requiring prior authorization and potentially step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H5619-089 (HMO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment benefits covered by Humana Gold Plus H5619-089 (HMO) require a 20% coinsurance and no copay for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay, with prior authorization required across these categories.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-089 (HMO) covers diagnostic and radiological services, with no copay or coinsurance required for lab services and outpatient X-rays. Diagnostic procedures carry a $0 to $50 copay with no coinsurance, diagnostic radiological services require a copay of up to $335 with no coinsurance, and therapeutic radiological services have a $30 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus H5619-089 (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-089 (HMO) does not cover Cardiac Rehabilitation Services. This includes cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation, none of which are covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-089 (HMO) covers Skilled Nursing Facility (SNF) services with no copay or coinsurance for days 1 through 20, and a $218 daily copay with no coinsurance for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-089 (HMO) partially covers Other Services, providing acupuncture with a $30 copay and no coinsurance, and chronic illness meal benefits with no copay and no coinsurance. Over-the-Counter (OTC) items and Dual Eligible SNPs with Highly Integrated Services are not covered.
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