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Humana Gold Plus H5619-119 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-119 (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 H5619-119 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-119 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in San Luis Obispo 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 H5619-119 (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 H5619-119 (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 H5619-119 (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $1000.00 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 H5619-119 (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, you'll pay a $10 copay for preferred generic drugs at a standard or preferred mail pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Humana Gold Plus H5619-119 (HMO) plan offers a range of benefits with varying costs. Many services have no copay, including primary care, outpatient services, preventive services, hearing exams, vision services, dental services, and home health services. Other services include copays, such as inpatient hospital stays, emergency services, ambulance services, and skilled nursing facilities, while some services have coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization and a doctor referral. For Inpatient Hospital-Acute, there is a $100 copay per admission or stay for Medicare-covered stays, and additional days have no copay, while Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, there is a $799 copay per admission or stay for Medicare-covered stays, and Additional Days and Non-Medicare-covered Stay are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with no copay, observation services with a $100 copay, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with no copay for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-119 (HMO) plan with no copay, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-119 (HMO) plan. Ground ambulance services have a $315 copay, and air ambulance services have 20% coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H5619-119 (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $10 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
Primary Care See details
The Humana Gold Plus H5619-119 (HMO) plan offers primary care services with no copay. Chiropractic services and mental health specialty services are covered with no copay, but require prior authorization and a doctor's referral. Occupational therapy services, physical therapy and speech-language pathology services, and physician specialist services are covered with no copay. Additional telehealth benefits are covered with a copay between $0 and $10.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. However, health education, in-home safety assessments, personal emergency response systems, and more are not covered.
Hearing Services See details
Hearing exams are covered with no copay, but require prior authorization and a doctor referral. Routine hearing exams have no copay and are covered once per year, and fitting/evaluation for hearing aids also have no copay. Prescription hearing aids are partially covered, with a copay between $399 and $699, while OTC hearing aids are covered with a maximum benefit of $100 every three months.
Vision Services See details
The Humana Gold Plus H5619-119 (HMO) plan covers vision services, including routine eye exams and eyewear. Routine eye exams and eyewear have no copay, with a limit of one routine eye exam and one pair of contact lenses or eyeglasses per year, and a combined maximum of $200 per year for all eyewear.
Dental Services See details
Dental services are covered, with an annual maximum benefit of $1,000. 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 are covered with no copay, while prosthodontics (fixed) has a 30% coinsurance and no copay. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-119 (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Diabetic Supplies have a 10% coinsurance and no copay. Durable Medical Equipment for use outside the home is not covered, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, are covered with a copay ranging from $0 to $10, while all other radiological services have a copay of at most $150 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-119 (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 referral.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. A doctor referral and prior authorization are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization and a doctor's referral. For days 1-20, there is a $20 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services include acupuncture with no copay, and a meal benefit with no copay. This plan also covers over-the-counter items with a maximum benefit coverage amount of $100 every three months. However, 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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