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Humana Gold Plus H5619-100 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-100 (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 H5619-100 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-100 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in WA. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-100 (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 H5619-100 (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 H5619-100 (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 $2.00. 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 $100.00 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 $6400.00 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 H5619-100 (HMO) plan has a $100 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and the pharmacy you use. For example, Tier 1 preferred generic drugs have a $10 copay at standard and mail order pharmacies, while Tier 2 standard generic drugs have a $47 copay. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-100 (HMO) plan offers a range of benefits, including inpatient hospital care with a copay of $495 for the first five days and no copay thereafter, and outpatient services with varying copays and coinsurance depending on the service. The plan also covers emergency, primary care, and preventive services with no or low copays. Additional benefits include hearing and vision services with copays, dental services with no copay, and home health services with no copay. The plan also covers a wide range of other services such as ambulance, partial hospitalization, and skilled nursing facility with varying cost-sharing.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Gold Plus H5619-100 (HMO), with a copay of $495 for days 1-5 and no copay for days 6-90 for acute care, and a copay of $435 for days 1-5 and no copay for days 6-90 for psychiatric care. Additional days for inpatient hospital-acute are covered with no copay, and additional days and non-Medicare-covered stays for psychiatric are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a 20% coinsurance and a copay between $0 and $495, while Observation Services have a $495 copay. Ambulatory Surgical Center Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a 20% coinsurance and no copay for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-100 (HMO) plan, but requires prior authorization. You will pay a $85 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $315 copay, and air ambulance services have a $1250 copay, but there is no coinsurance. Transportation services to any 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 H5619-100 (HMO) plan. Emergency Services has a $125 copay with no coinsurance, Urgently Needed Services has a $55 copay with no coinsurance, and Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-100 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $45 copay. The plan also covers physician specialist services with a $50 copay, and mental health specialty services and psychiatric services with no copay for individual and group sessions. Other health care professional services have a copay between $0 and $50, physical therapy and speech-language pathology services have a $45 copay, and additional telehealth benefits have a copay between $0 and $55. Opioid Treatment Program Services are covered with a 20% coinsurance and no copay.
Preventive Services See details
The Humana Gold Plus H5619-100 (HMO) plan covers preventive services with no copay for services such as an annual physical exam, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a welcome visit. Other services, such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Hearing Services are partially covered. Hearing exams require a $50 copay, but routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$50, while eyewear is covered with no copay; however, routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-100 (HMO) plan covers a variety of dental services, including oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), and other preventive services, with no copay. Medicare dental services require prior authorization and a doctor referral and have a $50 copay. The plan also covers orthodontic services, and restorative services, and adjunctive general services with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-100 (HMO) plan, but require prior authorization and a doctor's referral. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment is covered, including durable medical equipment with 20% coinsurance and prosthetics/medical supplies with 20% coinsurance. Diabetic equipment is covered, with coinsurance and copayments for some services, and diabetic supplies with between 10% and 20% coinsurance and no copay, and diabetic therapeutic shoes/inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay between $0 and $55, and lab services with no copay. Diagnostic Radiological Services have a copay up to $495, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-100 (HMO) plan with no copay and no coinsurance, though additional hours of care and personal care services are not covered. This benefit requires both authorization and a referral.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-100 (HMO) offers Cardiac Rehabilitation Services, but does not cover the following services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required to receive these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H5619-100 (HMO) plan, requiring prior authorization and a doctor's referral. For days 1-20, the copay is $10, for days 21-50 the copay is $214, and for days 51-100, there is no copay.
Other Services See details
Other Services with the Humana Gold Plus H5619-100 (HMO) plan covers acupuncture with a $50 copay, and meal benefits with no copay. However, over-the-counter items, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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