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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 2026, 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 out of 5 stars in 2026.
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.
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 $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 $3500.00 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) prescription drug plan features an annual drug deductible of $590. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies or through preferred mail order. Tier 2 generic medications cost as little as a $5 copay for a one-month supply, or no copay for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with a discounted $131 copay for a three-month supply through preferred mail order. For higher-tier medications, you will pay coinsurance rather than a flat copay, which includes 48% coinsurance for Tier 4 non-preferred drugs and 26% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The Humana Gold Plus H5619-095 (HMO) plan offers robust medical coverage with predictable costs, featuring no copay and no coinsurance for primary care visits and preventive services. For specialist visits, members pay a $30 copay, while inpatient hospital stays require a $200 daily copay for the first five days and no copay thereafter. Outpatient services are also highly affordable, requiring no coinsurance and no copay for ambulatory surgical center visits. This plan includes valuable supplemental benefits to help you save on everyday healthcare needs, such as dental, vision, and hearing care. You will enjoy no copay or coinsurance for routine hearing exams, routine eye exams, and preventive dental care up to a $2,000 annual limit. Additionally, the plan covers over-the-counter items and up to 36 one-way transportation trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Gold Plus H5619-095 (HMO) with no coinsurance and a daily copay of $200 for days 1 to 5, followed by no copay for days 6 to 90 for both acute and psychiatric stays. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-095 (HMO) covers outpatient services with no coinsurance, including no copays for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $300 (or $200 per stay for observation services), while outpatient substance abuse individual and group sessions require a $35 copay.
Partial Hospitalization See details
Humana Gold Plus H5619-095 (HMO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H5619-095 (HMO), featuring a $335 copay for ground ambulance services and a 20% coinsurance for air ambulance services, with prior authorization required. Additionally, transportation is partially covered with no copay or coinsurance for up to 36 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus H5619-095 (HMO) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-095 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Chiropractic services are partially covered, with routine and other chiropractic services not covered, while podiatry services are completely not covered. Other covered benefits, including physical therapy, mental health, and psychiatric services, require copays ranging from $20 to $35 and no coinsurance.
Preventive Services See details
Humana Gold Plus H5619-095 (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are only partially covered; while memory fitness and in-home support are covered with no copay and no coinsurance, several other supplemental services are not covered. Specifically, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, home safety devices, or counseling.
Hearing Services See details
Humana Gold Plus H5619-095 (HMO) offers hearing services with no deductibles, featuring routine hearing exams and fitting evaluations at no copay and no coinsurance, and Medicare-covered exams for a $30 copay and no coinsurance. OTC hearing aids have no copay and no coinsurance, while prescription hearing aids are partially covered—excluding inner ear, outer ear, and over the ear models—with a copay of $399 to $699 and no coinsurance for up to two devices per year.
Vision Services See details
Vision services under the Humana Gold Plus H5619-095 (HMO) plan are partially covered, offering no copay and no coinsurance for one routine eye exam and one pair of eyeglasses or contact lenses per year up to a $200 maximum. Other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered by the plan.
Dental Services See details
Humana Gold Plus H5619-095 (HMO) dental services are partially covered, requiring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other preventive and comprehensive services up to a $2,000 yearly maximum. While most dental care is covered, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-095 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require between no coinsurance and 20% coinsurance, while Part B insulin drugs have a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
The Humana Gold Plus H5619-095 (HMO) plan covers dialysis services with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Humana Gold Plus H5619-095 (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 and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H5619-095 (HMO) with no coinsurance for diagnostic services, no copays for lab and outpatient X-ray services, and diagnostic procedure copays ranging from $0 to $95. Therapeutic radiological services require a minimum 20% coinsurance and $30 copay, and prior authorization is required for all services.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H5619-095 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-095 (HMO) covers Cardiac Rehabilitation Services with no copay, no coinsurance, and prior authorization required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-095 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-095 (HMO) covers acupuncture for a $30 copay and no coinsurance, limited to 20 treatments per year. Over-the-counter (OTC) items and chronic illness meal benefits are also covered with no copay and no coinsurance, with prior authorization required for acupuncture and meals.
Get Personalized Help from a licensed insurance agent
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