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Humana Gold Plus H5619-090 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-090 (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 H5619-090 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-090 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Southwest Virginia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-090 (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 H5619-090 (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 H5619-090 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $79.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2000.00 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 H5619-090 (HMO) plan has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy. For example, you will have no copay for preferred generic drugs at a standard pharmacy, but a $20 copay at a standard mail pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-090 (HMO) plan offers a range of benefits with varying costs. You'll find no copay for inpatient hospital stays, many outpatient services, and preventive services, as well as routine hearing exams, eyewear, and several dental services. However, costs include a $140 copay for emergency services, a $315 copay for ground ambulance services, and coinsurance for air ambulance services. The plan also covers a variety of services with copays, such as primary care, specialist visits, and mental health services. Additionally, there are copays for prescription hearing aids, and diagnostic and radiological services. The plan includes coverage for home health services with no copay, but excludes certain services like cardiac rehabilitation and additional hours for home health care.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute, with no copay for a Medicare-covered stay, and Inpatient Hospital Psychiatric, with a $250 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, 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 with a copay between $0 and $225, observation services with no copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $15 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-090 (HMO) plan. You will pay a $15 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Gold Plus H5619-090 (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 by Humana Gold Plus H5619-090 (HMO). Emergency Services and Worldwide Emergency Coverage have a $140 copay, Urgently Needed Services have a $65 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $140 copay.
Primary Care See details
The Humana Gold Plus H5619-090 (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, Physical Therapy, and Speech-Language Pathology Services with a $20 copay. Mental Health and Psychiatric Services have a $15 copay for individual and group sessions, and the plan offers Additional Telehealth Benefits with a copay between $0 and $65.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as an annual physical exam with no copay. Additional services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear aids are not covered. OTC hearing aids are also covered with a maximum benefit of $50 every three months.
Vision Services See details
The Humana Gold Plus H5619-090 (HMO) plan covers vision services, including routine eye exams with a copay of $0 - $20, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $20 copay, and other dental services. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. Restorative Services and Prosthodontics (removable and fixed) have no copay but a 30-40% coinsurance. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Gold Plus H5619-090 (HMO), including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-090 (HMO) plan, but require prior authorization. The coinsurance for these services is 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 and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medicare-covered Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay, whereas Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $65, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a copay up to $25, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-090 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus H5619-090 (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H5619-090 (HMO) with a copay of $20 for days 1-20, and a copay of $214 for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Plus H5619-090 (HMO) plan covers acupuncture with a $20 copay, up to 20 treatments per year, and also covers over-the-counter (OTC) items up to $50 every three months. This plan also provides a meal benefit with no copay. Several other services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others.
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