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Humana Value Plus H5619-134 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Value Plus H5619-134 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Value Plus H5619-134 (HMO) in 2025, please refer to our full plan details page.
Humana Value Plus H5619-134 (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 3.5 out of 5 stars in 2025.
It's important to know that Humana Value Plus H5619-134 (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 Value Plus H5619-134 (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 Value Plus H5619-134 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $7.80. 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 $590.00 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 $9350.00 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 Value Plus H5619-134 (HMO) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for your drugs in each tier until your total drug costs reach $2000. If you qualify for the low-income subsidy (LIS), you will pay $7.80 for Part D drugs. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Value Plus H5619-134 (HMO) plan provides a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance amounts. This plan offers no copays for many services, such as preventive services, hearing aid fittings, and dental services, but may include coinsurance for some services like outpatient hospital services and vision exams. Additionally, the plan covers services like ambulance, emergency care, and home health, with specific copays and coinsurance structures.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $2,185 copay per stay, and for Inpatient Hospital Psychiatric, there is a $2,036 copay per stay; additional days and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
The Humana Value Plus H5619-134 (HMO) plan covers outpatient services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a 20% coinsurance, with no copay for outpatient hospital services and no coinsurance for observation services. Ambulatory surgical center services have a 20% coinsurance and no copay. Individual and group sessions for outpatient substance abuse have a 20% coinsurance. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Value Plus H5619-134 (HMO) plan. Ground Ambulance Services have a $315 copay, and Air Ambulance Services have a $1250 copay, but 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 under the Humana Value Plus H5619-134 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay, and all have no coinsurance.
Primary Care See details
The Humana Value Plus H5619-134 (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services have a 20% coinsurance. Individual and group sessions for mental health and psychiatric services have no copay. Additional telehealth benefits have a copay between $0 and $45.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and also covers an annual physical exam with no copay. Additional preventive services include Fitness Benefit with no copay for Memory Fitness, and Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams and no copay for Medicare-covered benefits and hearing aid fittings/evaluations. Prescription hearing aids are covered with no copay for all types, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Humana Value Plus H5619-134 (HMO) plan covers vision services, including eye exams with a 20% coinsurance and no copay, and eyewear with a 20% coinsurance. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Value Plus H5619-134 (HMO) plan offers dental services including Medicare dental services with 20% coinsurance, other dental services with a $1,000 maximum benefit per year, and coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics fixed, and oral and maxillofacial surgery with 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 under the Humana Value Plus H5619-134 (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Value Plus H5619-134 (HMO) plan. You will pay 20% coinsurance for these services, and prior authorization and a doctor referral are required.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic supplies have a 20% coinsurance with no copay. Diabetic therapeutic shoes/inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization and a doctor referral required. Diagnostic Procedures/Tests have a copay of up to $45 and a coinsurance of at least 20%, while Lab Services have no copay and a coinsurance of at least 20%. Diagnostic Radiological Services have a copay of up to $350 and a coinsurance of at least 20%, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $45 copay and a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Humana Value Plus H5619-134 (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Value Plus H5619-134 (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, a $214 copay for days 21-65, and no copay for days 66-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays, are not covered.
Other Services See details
The Humana Value Plus H5619-134 (HMO) plan covers acupuncture with 20% coinsurance and a limit of 20 treatments per year, and also covers a meal benefit with no copay. The plan does not cover Over-the-Counter (OTC) items, Dual Eligible SNPs with Highly Integrated Services, 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, or Self-Directed Personal Assistance Services.
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