A non-government entity
Humana Gold Plus H5619-133 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-133 (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 H5619-133 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-133 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in WA. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-133 (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 H5619-133 (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 H5619-133 (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 $1.00. 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 a $300.00 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 $6550.00 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:
Sign up for Humana Gold Plus H5619-133 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H5619-133 (HMO) prescription drug plan has a $300 annual deductible and features multiple ways to save on generic medications. For Tier 1 preferred generics, you will pay no copay for both one-month and three-month supplies at standard pharmacies or through preferred mail order. Tier 2 generic drugs are available for a $10 copay for a one-month supply at standard pharmacies and preferred mail order, with no copay required for a three-month supply filled via preferred mail order. Brand-name and higher-tier medications under this plan are subject to copays or coinsurance depending on the drug tier. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, while Tier 4 non-preferred drugs carry a 50% coinsurance. Tier 5 specialty drugs require a 29% coinsurance for a one-month supply, helping you easily plan your healthcare expenses.
Additional Benefits
The Humana Gold Plus H5619-133 (HMO) plan offers affordable coverage with no copays or coinsurance for primary care doctor visits, preventive services, home health care, and diagnostic lab work. Routine vision and hearing exams also have no copay, and the plan includes a $250 annual eyewear allowance alongside a $1,000 yearly limit for preventive and comprehensive dental care. For other outpatient needs, members will pay a $40 copay for specialist visits and physical therapy, and a $130 copay for emergency room visits, which is waived upon hospital admission. For more intensive medical care, the plan utilizes structured copays and coinsurance instead of deductibles. Inpatient hospital stays require a $495 daily copay for the first five days, with no copay for additional days, while skilled nursing care requires daily copays for days 1 through 55. Additionally, specialized services such as dialysis, durable medical equipment, and therapeutic radiology require a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-133 (HMO) covers inpatient hospital services with no coinsurance, requiring a $495 daily copay for days 1 to 5 of acute stays (no copay for days 6 and beyond) and a $465 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Prior authorization is required, and the benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-133 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $450 with no coinsurance, observation services require a $495 copay per stay with no coinsurance, and outpatient substance abuse sessions have a copay of $0 to $35 with no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H5619-133 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-133 (HMO) covers ambulance services with no coinsurance, requiring a $335 copay for ground transport and a $1,250 copay for air transport, with prior authorization required for both. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H5619-133 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-133 (HMO) primary care benefits feature no copay and no coinsurance for primary care physician visits, whereas specialist, occupational, and physical therapy services require a $40 copay and no coinsurance. Mental health and psychiatric sessions are available with no copay and no coinsurance, but podiatry is not covered, and for chiropractic services, some services are covered though routine and other chiropractic services are not.
Preventive Services See details
Humana Gold Plus H5619-133 (HMO) offers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and a memory fitness benefit. However, additional preventive benefits are only partially covered, excluding services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services under the Humana Gold Plus H5619-133 (HMO) plan feature no coinsurance and no deductibles, with a $40 copay for Medicare-covered exams and no copay for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with a copay between $599 and $899 for up to two devices per year, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-133 (HMO) provides partially covered vision services with no copay, no coinsurance, and no deductible for one annual routine eye exam and select eyewear up to a $250 yearly limit. Under this plan, contact lenses and complete eyeglasses are covered, but other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-133 (HMO) dental services are partially covered, offering Medicare-covered dental with a $40 copay and no coinsurance, and other preventive and comprehensive dental benefits with no copay and no coinsurance up to a $1,000 yearly limit. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H5619-133 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Related Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H5619-133 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H5619-133 (HMO) medical equipment benefits cover durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-133 (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay. Diagnostic tests and procedures have no coinsurance and a copay ranging from $0 to $50, while therapeutic radiological services require a minimum 20% coinsurance and diagnostic radiological services have a minimum $0 copay.
Home Health Services See details
Humana Gold Plus H5619-133 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-133 (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered by the plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-133 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 55, and no copay for days 56 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Humana Gold Plus H5619-133 (HMO) covers acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, alongside over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, and some other miscellaneous services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved