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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 2025, 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 3.5 out of 5 stars in 2025.
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 $2.00. 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 $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 $6100.00 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 has a $590.00 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you can expect to pay a $10.00 copay at preferred mail and standard pharmacies, and a $20.00 copay at standard mail pharmacies. For standard generic drugs, the copay is $47.00, and for preferred brand drugs, you will pay 40% coinsurance.
Additional Benefits
The Humana Gold Plus H5619-089 (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have a mix of copays and no copays depending on the service. Emergency, primary care, hearing, vision, and dental services are covered with copays, and preventative services have no copay. This plan also includes coverage for ambulance, home health, and skilled nursing facilities with copays or coinsurance. Diagnostic, radiological, and medical equipment services are covered with copays or coinsurance. Additional benefits include partial hospitalization, home infusion, dialysis, and other services such as acupuncture, but some require prior authorization.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-8, and no copay for days 9-90, and for Inpatient Hospital Psychiatric, you will pay a $272 copay for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay of $0-$260, and observation services with a copay of $295. Ambulatory Surgical Center (ASC) Services have no copay, while Outpatient Substance Abuse Services have a copay of $25 for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $25 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-089 (HMO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% coinsurance; however, Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H5619-089 (HMO) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $55 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $125 copay.
Primary Care See details
The Humana Gold Plus H5619-089 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $20 copay. The plan also covers physician specialist services with a $25 copay, mental health and psychiatric services with a $25 copay, and physical therapy and speech-language pathology services with a $20 copay. Additionally, the plan covers additional telehealth benefits with a copay between $0 and $55, and opioid treatment program services with a $25 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include no copay for an annual physical exam, and other services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit also have no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay up to $299, while prescription hearing aids for the inner, outer, and over-the-ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H5619-089 (HMO) plan covers vision services, including eye exams with a copay between $0 and $25. Eyewear benefits are covered with no copay, and a combined maximum benefit of $250 per year. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-089 (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare dental services have a $25 copay. There is a $2,000 annual maximum for dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus H5619-089 (HMO) plan, with a coinsurance of 20%. Prior authorization is required for this benefit.
Medical Equipment See details
The Humana Gold Plus H5619-089 (HMO) plan covers medical equipment, including durable medical equipment (DME), prosthetic devices, medical supplies, and diabetic equipment, with prior authorization required for some services. DME has a 20% coinsurance and no copay, while prosthetic devices also have a 20% coinsurance with copayments for Medicare-covered devices. Diabetic supplies have a 10-20% coinsurance with no copay, and diabetic therapeutic shoes/inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, with a copay between $0 and $55 for diagnostic procedures and tests, and no copay for lab services. Diagnostic radiological services have a copay up to $300, therapeutic radiological services have a copay between $20 and $25, and outpatient X-rays have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-089 (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 by the Humana Gold Plus H5619-089 (HMO) plan, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit, and the copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-089 (HMO) plan with prior authorization required. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture and a meal benefit, with the acupuncture benefit costing a $25 copay and a limit of 20 treatments per year. Over-the-counter items, 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, and Self-Directed Personal Assistance Services are not covered.
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