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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 2026, 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 out of 5 stars in 2026.
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.
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 $615.00 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 $720.00 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 features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay a $10.00 copay for preferred generics and a $47.00 copay for standard generics at standard pharmacies or through preferred mail. Preferred brand drugs require a 50% coinsurance, while non-preferred drugs carry a 25% coinsurance. If you qualify for the Extra Help low-income subsidy, your Part D cost-sharing is reduced to no cost. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase where you pay nothing for covered Part D prescription drugs.
Additional Benefits
The Humana Gold Plus H5619-119 (HMO) plan offers robust coverage with no copay and no coinsurance for primary care doctor visits, specialist appointments, and Medicare-covered acute inpatient hospital stays. For emergency care, members pay a $150 copay with no coinsurance, which is waived if admitted within 24 hours. Outpatient hospital services and diagnostic lab tests are also highly affordable, with many services requiring no copay and no coinsurance. This plan also includes valuable supplemental benefits, featuring no copay and no coinsurance for routine vision exams and select eyewear up to a $250 annual limit, as well as routine dental care up to a $1,250 yearly maximum. Routine hearing exams and over-the-counter hearing aids are covered with no copay, while prescription hearing aids require a copay of $499 to $799. Additionally, members can access home health services, acupuncture, and over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by Humana Gold Plus H5619-119 (HMO), with Medicare-covered acute stays requiring no copay and no coinsurance, and psychiatric stays requiring a $720 copay per admission and no coinsurance. Prior authorization and doctor referrals are required for these services, while upgrades for acute stays, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-119 (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical, blood, and observation services. Outpatient hospital services and substance abuse sessions require copays ranging from $0 to $35, with prior authorizations and doctor referrals required for most of these benefits.
Partial Hospitalization See details
Humana Gold Plus H5619-119 (HMO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Humana Gold Plus H5619-119 (HMO), with transportation services to plan-approved or any health-related locations not covered. Ground ambulance services require a $335 copay and no coinsurance, while air ambulance services require 20% coinsurance and no copay.
Emergency Services See details
Humana Gold Plus H5619-119 (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered under a $150 copay with no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by Humana Gold Plus H5619-119 (HMO), offering no copay and no coinsurance for primary care, specialist, and therapy visits, while podiatry and routine chiropractic services are not covered. Other covered services, such as mental health, psychiatric, telehealth, and opioid treatment, require copays ranging from $0 to $65 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H5619-119 (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, and other preventive screenings. While some additional preventive services are covered, sub-services like fitness benefits, health education, weight management, alternative therapies, and caregiver support are not covered in practice.
Hearing Services See details
Humana Gold Plus H5619-119 (HMO) covers hearing exams and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $499 to $799 and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H5619-119 (HMO), offering one routine eye exam and select eyewear yearly with no copays, no coinsurance, and a $250 annual limit. Covered eyewear includes contact lenses and eyeglasses (lenses and frames), while separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-119 (HMO) partially covers dental services up to a $1,250 annual maximum, though fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Most covered services feature no copay and no coinsurance, while fixed and removable prosthodontics require a 30% coinsurance and no copay.
Home Infusion bundled Services See details
Humana Gold Plus H5619-119 (HMO) covers home infusion bundled services with prior authorization, offering chemotherapy, radiation, and other Part B drugs with no copay and coinsurance ranging from no coinsurance to 20%. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus H5619-119 (HMO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive this covered benefit.
Medical Equipment See details
Humana Gold Plus H5619-119 (HMO) covers durable medical equipment and prosthetic devices with a 20% coinsurance, featuring no copay for durable medical equipment. Diabetic supplies are covered with a 10% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay, with prior authorization required for most equipment.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-119 (HMO) covers diagnostic and radiological services with prior authorization and a doctor referral. Members pay no copay and no coinsurance for lab services and outpatient X-rays, a $0 to $65 copay and no coinsurance for diagnostic procedures, a $0 to $300 copay and no coinsurance for diagnostic radiology, and a 20% coinsurance with no copay for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H5619-119 (HMO) with no copay and no coinsurance. A doctor referral and prior authorization are required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H5619-119 (HMO) plan, with no coverage provided for intensive cardiac, pulmonary, or supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-119 (HMO) partially covers Skilled Nursing Facility (SNF) services, with no coverage for additional days beyond the Medicare-covered limit. There is no coinsurance for this benefit, but you will pay a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100.
Other Services See details
Other Services are partially covered by Humana Gold Plus H5619-119 (HMO), featuring no copay and no coinsurance for acupuncture, over-the-counter items, and meal benefits. Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit, and prior authorization is required for acupuncture and meals.
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