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Humana Gold Plus H5619-091 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-091 (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 H5619-091 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-091 (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 H5619-091 (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 H5619-091 (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 H5619-091 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.00. 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 $2600.00 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 H5619-091 (HMO) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply at standard pharmacies and offer no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with 3-month supplies costing $141 at standard pharmacies or a reduced $131 through preferred mail order. Higher-tier medications require coinsurance instead of flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus H5619-091 (HMO) plan offers robust coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $25 copay, while inpatient hospital stays cost a $175 daily copay for the first five days and no copay for days six through ninety. Emergency room visits carry a $150 copay, which is waived if you are admitted within 24 hours. For supplemental care, the plan features a $2,500 annual maximum for dental services with no copay for most preventive care, alongside no copay for routine vision and hearing exams. Durable medical equipment and dialysis services require a 20% coinsurance with no copay. Prescription hearing aids are covered with copays ranging from $399 to $699, and eyewear is covered up to a $250 annual limit.
Inpatient Hospital See details
Humana Gold Plus H5619-091 (HMO) partially covers inpatient hospital stays with no coinsurance, requiring a $175 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute hospital days are covered at no copay, but additional psychiatric days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-091 (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $275 for outpatient hospital services and $175 per stay for observation services. Outpatient substance abuse sessions require a $35 copay, while ambulatory surgical center and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the Humana Gold Plus H5619-091 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance services under the Humana Gold Plus H5619-091 (HMO) require prior authorization, carrying a $335 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport. Transportation services to plan-approved or any health-related locations are not covered by this plan.
Emergency Services See details
Emergency services are covered under the Humana Gold Plus H5619-091 (HMO) plan with a $150 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered for a $150 copay per service with no coinsurance.
Primary Care See details
Humana Gold Plus H5619-091 (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, and speech therapies, along with partially covered chiropractic services, have a $20 copay and no coinsurance, but routine chiropractic and podiatry services are not covered. Mental health, psychiatric, and opioid treatment services require a $35 copay and no coinsurance, while telehealth benefits range from no copay to a $65 copay and no coinsurance.
Preventive Services See details
Humana Gold Plus H5619-091 (HMO) partially covers preventive services with no copay and no coinsurance for annual exams, kidney disease education, diabetes self-management, and select fitness benefits. Uncovered supplemental services under this plan include health education, weight management, medical nutrition therapy, therapeutic massage, and home safety assessments.
Hearing Services See details
Humana Gold Plus H5619-091 (HMO) hearing services include Medicare-covered exams for a $25 copay and no coinsurance, while routine exams, fittings, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $399 to $699 for up to two aids per year, though inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are covered by Humana Gold Plus H5619-091 (HMO) with no coinsurance, no deductibles, and a copay of up to $25 for eye exams, though routine exams and covered eyewear have no copay. Eyewear is covered up to a $250 annual limit, but other eye exams, individual eyeglass lenses or frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by the Humana Gold Plus H5619-091 (HMO) plan up to a $2,500 annual maximum, with Medicare-covered dental requiring a $25 copay and no coinsurance. Most other covered preventive and comprehensive services have no copay and no coinsurance, though some services require a 30% to 40% coinsurance, and fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H5619-091 (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus H5619-091 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Humana Gold Plus H5619-091 (HMO) covers durable medical equipment, 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 or inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-091 (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for labs and a $0 to $100 copay for tests, while radiological services range from no copay for X-rays to a minimum $25 copay and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H5619-091 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-091 (HMO) provides coverage for some Cardiac Rehabilitation Services with no coinsurance, although standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H5619-091 (HMO) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, but a three-day inpatient hospital stay is not required prior to admission.
Other Services See details
Humana Gold Plus H5619-091 (HMO) covers acupuncture for up to 20 treatments per year with a $25 copay and no coinsurance, requiring prior authorization. Over-the-counter items and meal benefits for chronic illnesses are also covered with no copay and no coinsurance, while other additional services are not covered.
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