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Humana Gold Plus H5619-130 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-130 (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 H5619-130 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-130 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Santa Barbara (partial) and Ventura counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-130 (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 H5619-130 (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 H5619-130 (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 $4.00. 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 $5500.00 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 H5619-130 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay a $10 copay for preferred generic drugs at a preferred or standard mail pharmacy, or a $20 copay at a standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-130 (HMO) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $350, and emergency services with a $125 copay. Primary care visits have no copay, but specialist visits have a $15 copay, and other services like hearing, vision, and dental have copays as well. Preventive services, including an annual physical exam, have no copay, and there is also coverage for hearing aids and vision services with a maximum benefit. The plan also includes coverage for home health services with no copay, and offers additional benefits like acupuncture, over-the-counter items, and a meal benefit. However, be aware that some services like dialysis and durable medical equipment have coinsurance, and other services may require prior authorization.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a copay of $410 for days 1-6, and no copay for days 7-90; additional days have no copay. Inpatient Hospital Psychiatric has a copay of $900.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $350, and observation services with a $410 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a copay between $10 and $100 for individual and group sessions.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus H5619-130 (HMO) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Humana Gold Plus H5619-130 (HMO). Ground ambulance services have a $315 copay, while air ambulance services have a $1250 copay, and there is no coinsurance for either. 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 by the Humana Gold Plus H5619-130 (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $125 copay, while Urgently Needed Services have a $20 copay.
Primary Care See details
The Humana Gold Plus H5619-130 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $10 copay, while occupational therapy services have a $10 copay, and both require a referral. Physician specialist services have a $15 copay, and physical therapy and speech-language pathology services have a $10 copay, both requiring a referral. Individual and group sessions for mental health and psychiatric services have a $40 copay. Additional telehealth benefits range from $0 to $40, and opioid treatment program services have a copay between $10 and $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus H5619-130 (HMO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, are covered with no copay.
Hearing Services See details
Hearing services include hearing exams with a $15 copay, and routine hearing exams with no copay for one exam per year. Fitting and evaluation for hearing aids have no copay, and prescription hearing aids (all types) have a copay between $699 and $999 for two aids per year. OTC hearing aids are covered up to $75 every three months.
Vision Services See details
The Humana Gold Plus H5619-130 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$15 and eyewear with no copay, including contact lenses and eyeglasses (lenses and frames), with a combined maximum benefit of $150 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-130 (HMO) plan offers dental services with a $1,000 maximum benefit per year. Medicare dental services require a $15 copay, while oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), and other preventative services have no copay. Prosthodontics, fixed services have a 30% coinsurance and no copay, and oral and maxillofacial surgery has no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Other Medicare Part B Drugs have a $100 copay, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-130 (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 30% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay between $0 and $50, and lab services with no copay. Diagnostic radiological services have a copay up to $100, and therapeutic radiological services have 20% coinsurance. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H5619-130 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the listed sub-services are covered. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-130 (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Plus H5619-130 (HMO) plan covers acupuncture with a $15 copay, and up to 20 treatments per year, as well as over-the-counter items with a maximum benefit of $75 every three months. The plan also covers a meal benefit with no copay, and provides meals for chronic illnesses. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others, are not covered.
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