Humana Gold Plus H5619-135 (HMO)

Humana Gold Plus H5619-135 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Roanoke. This plan received an overall rating of 3 out of 5 stars in 2026.

It's important to know that Humana Gold Plus H5619-135 (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 H5619-135 (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.

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:

Drug Coverage

The Humana Gold Plus H5619-135 (HMO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications cost a $5 copay for a 1-month supply at standard pharmacies, with no copay required for a 3-month supply filled through preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply at standard pharmacies and mail order options. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 44% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. These structured cost-sharing tiers help you understand your out-of-pocket expenses when choosing the Humana Gold Plus H5619-135 (HMO) plan.

Additional Benefits

The Humana Gold Plus H5619-135 (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For more intensive medical needs, inpatient hospital stays require a $375 daily copay for the first five to seven days before transitioning to no copay, while emergency room visits carry a $115 copay and specialist visits require a $35 copay. Outpatient hospital services and surgeries are covered with no coinsurance and copays ranging from no copay up to $450 depending on the service. This plan also includes essential dental, vision, and hearing benefits, featuring no copay for preventive dental care up to a $1,000 annual limit and no copay for eyewear up to a $350 yearly allowance. Diagnostic lab work and outpatient X-rays are available with no copay, whereas durable medical equipment and dialysis services generally require a 20% coinsurance. Additionally, skilled nursing facility stays are covered with no coinsurance, requiring no copay for the first 20 days and a $218 daily copay for days 21 through 100.