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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 2026, 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 out of 5 stars in 2026.
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 $74.00. 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 $1800.00 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 features a $615 annual prescription drug deductible. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for 1-month and 3-month supplies at standard pharmacies and through preferred mail order. Standard mail order for these generic tiers requires copays ranging from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, while 3-month supplies cost $131 through preferred mail order and $141 through standard pharmacies or standard mail order. Tier 4 non-preferred drugs require a 50% coinsurance for both 1-month and 3-month supplies. Specialty medications in Tier 5 are covered with a 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H5619-090 (HMO) plan offers comprehensive coverage with no copay or coinsurance for inpatient hospital stays, primary care visits, and routine preventive services. Members enjoy extensive dental benefits up to a $3,000 annual maximum with no copay for preventive care, as well as routine vision and hearing exams with no copay. Specialist visits, physical therapy, and diagnostic lab tests are also highly accessible, requiring only low copays and no coinsurance. Emergency room visits carry a $150 copay, which is waived if admitted, while urgent care services require a $65 copay. For specialized medical needs, home health services are available with no copay, though durable medical equipment and dialysis require a 20% coinsurance. Skilled nursing care is covered with no copay for the first 20 days, and the plan also includes over-the-counter items, meal benefits, and acupuncture services with low or no copays.
Inpatient Hospital See details
Humana Gold Plus H5619-090 (HMO) covers Medicare-approved inpatient acute and psychiatric hospital stays with no copay and no coinsurance, subject to prior authorization. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-090 (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a copay of $0 to $225, and ambulatory surgical center, observation, and blood services with no copay. Outpatient substance abuse individual and group sessions are covered with a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H5619-090 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-090 (HMO) covers ambulance services with prior authorization, requiring a $335 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Humana Gold Plus H5619-090 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-090 (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $20 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services have a $35 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H5619-090 (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. The benefit is partially covered, as it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H5619-090 (HMO) with no coinsurance, offering a $20 copay for Medicare-covered exams and no copay for routine annual exams, fittings, and OTC hearing aids. Prescription hearing aids are partially covered with no coinsurance and copays up to $299, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H5619-090 (HMO) with no coinsurance, featuring a $0 to $20 copay for eye exams (no copay for annual routine exams) and no copay for eyewear up to a $300 yearly limit. One routine eye exam and one pair of contact lenses or eyeglasses are covered annually, while other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-090 (HMO) covers dental services up to a $3,000 annual maximum, offering no copay and no coinsurance for preventive care, and a $20 copay with no coinsurance for Medicare-covered dental. Comprehensive services feature no copay and range from no coinsurance to 40% coinsurance, though the benefit is partially covered as 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 H5619-090 (HMO) with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs are covered with a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H5619-090 (HMO) with no copay and a 20% coinsurance. Prior authorization is required before receiving these services.
Medical Equipment See details
Humana Gold Plus H5619-090 (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-090 (HMO) covers diagnostic and radiological services, with prior authorization required. Diagnostic procedures and lab services have no coinsurance, featuring no copay for labs and a $0 to $65 copay for procedures, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $20 copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H5619-090 (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-090 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by Humana Gold Plus H5619-090 (HMO) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services covered by Humana Gold Plus H5619-090 (HMO) include acupuncture with a $20 copay and no coinsurance for up to 20 treatments per year. Over-the-counter items and meal benefits for chronic illnesses are also covered with no copay and no coinsurance, though prior authorization is required for acupuncture and meal services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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