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Humana Gold Plus H5619-143 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-143 (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 H5619-143 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-143 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Spokane County. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-143 (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 H5619-143 (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 H5619-143 (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 $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 $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 H5619-143 (HMO) plan features an annual drug deductible of $615 and offers affordable options for generic medications. For Tier 1 preferred generics, you pay no copay at standard pharmacies and through preferred mail order, while standard mail order costs up to a $30 copay. Tier 2 generic drugs cost a $12 copay for a 1-month supply at standard pharmacies and preferred mail order, though you can get a 3-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with 3-month supplies costing $131 through preferred mail order or $141 at standard pharmacies. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance. Specialty Tier 5 drugs require a 25% coinsurance for a 1-month supply across standard pharmacies and mail-order options.
Additional Benefits
The Humana Gold Plus H5619-143 (HMO) plan offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care, mental health, and preventive visits. Specialist visits require a $35 copay, while inpatient hospital stays carry a $375 daily copay for the first five days and no copay for subsequent days up to day ninety. Emergency room visits are covered with a $130 copay, and urgent care visits require a $50 copay, both with no coinsurance. This plan also includes valuable supplemental benefits, providing routine hearing exams, routine vision care up to a $200 limit, and preventive dental services up to a $1,500 limit with no copay and no coinsurance. For durable medical equipment and dialysis services, members can expect no copay alongside a standard 20% coinsurance. Additionally, home health services and diagnostic lab tests are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-143 (HMO) inpatient hospital coverage is partially covered with no coinsurance and requires prior authorization. For both acute and psychiatric stays, there is a $375 daily copay for days 1 through 5 and no copay for days 6 through 90, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-143 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $375 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have a copay of $0 to $35.
Partial Hospitalization See details
Humana Gold Plus H5619-143 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-143 (HMO) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, both featuring no coinsurance and requiring prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H5619-143 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-143 (HMO) covers primary care, mental health, and psychiatric services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and speech therapies are available with a $45 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H5619-143 (HMO) provides partially covered preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, diabetes self-management training, glaucoma screenings, digital rectal exams, and a memory fitness benefit. Multiple supplemental services, such as health education, nutritional therapy, in-home safety assessments, and personal emergency response systems, are not covered.
Hearing Services See details
Humana Gold Plus H5619-143 (HMO) covers routine hearing exams and OTC hearing aids with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $699 to $999 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 H5619-143 (HMO) with no coinsurance and no deductibles, though prior authorization is required. Routine eye exams and eyewear, including one pair of contact lenses or eyeglasses per year, are covered with no copay up to a $200 annual limit, while other eye exams, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-143 (HMO) with a $1,500 annual limit, featuring no copay and no coinsurance for preventive and most comprehensive care, while Medicare-covered dental services require a $35 copay and no coinsurance. Prior authorization is required for comprehensive procedures, and fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-143 (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H5619-143 (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus H5619-143 (HMO) covers medical equipment, offering durable medical equipment (DME), 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
Diagnostic and radiological services are covered by Humana Gold Plus H5619-143 (HMO) with prior authorization required. Diagnostic lab services have no copay and no coinsurance, diagnostic procedures range from no copay up to $50, outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H5619-143 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H5619-143 (HMO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease rehabilitation services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-143 (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 50, and no copay for days 51 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-143 (HMO) partially covers other services, offering acupuncture with a $35 copay and no coinsurance, and both over-the-counter items and chronic illness meals with no copay and no coinsurance. Specific sub-services including Other 1, Other 2, Other 3, and highly integrated services for dual eligible SNPs are not covered.
Get Personalized Help from a licensed insurance agent
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