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Humana Gold Plus H5619-116 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-116 (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 H5619-116 (HMO) in 2025, please refer to our full plan details page.
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 3.5 out of 5 stars in 2025.
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.
For Humana Gold Plus H5619-116 (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 $6.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $2100.00 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 H5619-116 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $47 copay, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. This plan may have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Humana Gold Plus H5619-116 (HMO) plan offers comprehensive coverage with no copays for many services. This includes primary care, outpatient services, preventive services, vision, hearing, dental, and home health services. The plan also provides benefits for inpatient hospital stays, emergency services, and ambulance services with varying copays and coinsurance. This plan offers additional benefits like coverage for medical equipment, diagnostic services, and dialysis services, all with coinsurance. It also includes coverage for acupuncture, OTC items, and a meal benefit. However, some services such as additional hospital days, non-medicare covered stays, and certain dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered under the Humana Gold Plus H5619-116 (HMO) plan. For Inpatient Hospital-Acute, there is no copay for a Medicare-covered stay, and Additional Days are covered with no copay; however, Non-Medicare-covered Stay and Upgrades are not covered. Inpatient Hospital Psychiatric has a $900 copay for a Medicare-covered stay, but Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered with no copay. Outpatient substance abuse services include both individual and group sessions, both with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H5619-116 (HMO) plan, with no copay required. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H5619-116 (HMO). Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency services, are covered under the Humana Gold Plus H5619-116 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgent Services has no copay.
Primary Care See details
The Humana Gold Plus H5619-116 (HMO) plan offers primary care services with no copay, and chiropractic services, physician specialist services, mental health specialty services (individual and group sessions), psychiatric services (individual and group sessions), physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services with no copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, as well as additional preventive services, kidney disease education services, and other preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams and routine hearing exams have no copay, while fitting/evaluation for hearing aids also has no copay; prescription hearing aids (all types) have a copay between $599 and $899. OTC hearing aids are covered up to $75 every three months.
Vision Services See details
Vision services are covered, including routine eye exams and eyewear. Routine eye exams and eyewear have no copay, and you are eligible for 1 routine eye exam per year, 1 pair of contact lenses per year, and 1 pair of eyeglasses (lenses and frames) per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-116 (HMO) plan offers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery with no copay. Prosthodontics, fixed services have a 30% coinsurance and no copay, while fluoride treatment, prosthodontics removable, maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $2,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-116 (HMO) plan. You will pay a 20% coinsurance for these services, and prior authorization and a doctor referral are required.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. DME has a 20% coinsurance and no copay, while Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Supplies have a 10% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and lab services with no copay, and outpatient X-ray services with no copay. Therapeutic Radiological Services have a 20% coinsurance, and other services may have a copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-116 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization and a referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services like Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-116 (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $50 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H5619-116 (HMO) plan covers acupuncture with no copay, OTC items up to $75 every three months, and a meal benefit with no copay. Other services, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, are not covered.
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