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Humana Gold Plus H5619-095 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-095 (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 H5619-095 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-095 (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 H5619-095 (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 H5619-095 (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 H5619-095 (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 $4.00. 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 $3850.00 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 H5619-095 (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 example, you will pay a $10.00 copay for preferred generic drugs at a standard pharmacy. For brand-name drugs, you will pay 50% coinsurance in the initial coverage phase. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-095 (HMO) plan offers a wide range of benefits with varying costs. It provides coverage for inpatient and outpatient hospital services, primary care, and emergency services with copays ranging from $0 to $225. The plan also includes coverage for hearing, vision, and dental services, with specific copays and annual maximums. Additional benefits include coverage for ambulance services, home health, and skilled nursing facilities, along with coverage for medical equipment, and diagnostic and radiological services. The plan also offers coverage for services like acupuncture and over-the-counter items, providing a comprehensive approach to healthcare.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $225 copay for days 1-6, and no copay for days 7-90; for days 91-999, there is no copay. For Inpatient Hospital Psychiatric, you will pay a $225 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a copay between $0 and $300, observation services with a $225 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-095 (HMO) plan with a $25 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-095 (HMO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% coinsurance, and transportation services to a health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H5619-095 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $65 copay; all services have no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-095 (HMO) plan covers primary care physician services with no copay, while chiropractic services have a $20 copay. Occupational therapy services have a $20 copay, and physician specialist services have a $35 copay. Mental health and psychiatric individual and group sessions have a $25 copay, and physical therapy and speech-language pathology services have a $20 copay. Additional telehealth benefits range from no copay to a $65 copay, and opioid treatment program services have a $25 copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Additional preventive services, including health education, in-home safety assessments, and more, are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, and OTC hearing aids with a maximum benefit of $90 every three months. Prescription hearing aids are partially covered, with all types of hearing aids having a copay between $399 and $699, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H5619-095 (HMO) plan covers vision services, including routine eye exams with a copay between $0 and $35, and eyewear with a $0 copay and a combined maximum of $150 per year. Contact lenses and eyeglasses (lenses and frames) are covered with a $0 copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-095 (HMO) plan offers dental services with a $2,000 annual maximum. Medicare dental services have a $35 copay, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics fixed, and oral and maxillofacial surgery all have no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H5619-095 (HMO) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-095 (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies with 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Gold Plus H5619-095 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $95. Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, Therapeutic Radiological Services have a copay up to $35, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-095 (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, but not Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required, and the copay for covered services is listed elsewhere in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H5619-095 (HMO) with a copay of $20 for days 1-20 and $214 for days 21-100; however, additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
The Humana Gold Plus H5619-095 (HMO) plan covers acupuncture with a $35 copay, and covers over-the-counter items up to $90 every three months, with the amount carrying over if unused, as well as a meal benefit with no copay. Additional services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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