Humana Gold Plus H5619-116 (HMO)

Humana Gold Plus H5619-116 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Kern County. This plan received an overall rating of 3 out of 5 stars in 2026.

It's important to know that Humana Gold Plus H5619-116 (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 H5619-116 (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.

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:

Drug Coverage

The Humana Gold Plus H5619-116 (HMO) plan features an annual prescription drug deductible of $615.00. After meeting this deductible, you enter the initial coverage phase where Tier 1 preferred generic drugs cost a $5.00 copay at standard pharmacies and preferred mail-order services, while Tier 2 standard generics require a $47.00 copay. Brand-name drugs in Tier 3 and non-preferred drugs in Tier 4 require a 50% and 25% coinsurance, respectively, until your total drug costs reach $2,100.00. If you qualify for the low-income subsidy (Extra Help), you will have no copays or premiums for Part D covered drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for covered Part D prescriptions. This plan offers an Enhanced Alternative drug benefit designed to keep your ongoing medication costs manageable.

Additional Benefits

The Humana Gold Plus H5619-116 (HMO) plan offers robust coverage for essential medical needs, featuring no copay and no coinsurance for acute inpatient hospital stays, primary care visits, specialist consultations, and preventive services. For outpatient care, diagnostic labs, and home health services, members also benefit from no copayments, while emergency room visits require a $150 copay and ground ambulance services carry a $335 copay. Skilled nursing facility stays are covered with no copay for the first 20 days, though a $218 daily copay applies for days 21 through 100. Supplemental benefits include dental coverage up to a $2,000 annual limit with no copay for most treatments, alongside a $300 annual allowance for eyewear and no-copay routine hearing exams. Prescription hearing aids require a copay ranging from $99 to $399, while durable medical equipment and dialysis services are covered with coinsurance rates of 15% and 20% respectively. Additionally, members can access covered over-the-counter items, meal benefits, and acupuncture treatments with no copay and no coinsurance.