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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 2025, 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 3.5 out of 5 stars in 2025.
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 $2.00. 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 $5900.00 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 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 pharmacy used. For example, you may pay a $12 copay for a preferred generic drug at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Humana Gold Plus H5619-143 (HMO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and emergency care. You'll have access to primary care, preventive, vision, and dental services with no or low copays. The plan also includes coverage for home health services, medical equipment, and various therapies, with specific cost-sharing arrangements like copays and coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered with a $375 copay for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $0-$375 copay and 20% coinsurance, Observation Services with a $375 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a 20% coinsurance and a $30 copay, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral are required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered with a $85 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for both ground and air ambulance services. Ground ambulance services have a copay of $315.00, while air ambulance services have a copay of $1250.00, and there is no coinsurance for either service. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered under this plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are also covered, each with a $125 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-143 (HMO) plan covers primary care physician services with no copay and chiropractic services with a $20 copay. Occupational therapy services have a $45 copay, while physician specialist services have a $50 copay. Mental health and psychiatric individual and group sessions have no copay. Physical therapy and speech-language pathology services have a $45 copay, and additional telehealth benefits range from no copay to a $55 copay. Opioid treatment program services have a 20% coinsurance and a $30 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, and an annual physical exam with no copay. Additional preventive services, including Health Education, In-Home Safety Assessment, and others, are not covered.
Hearing Services See details
Hearing services include hearing exams with a $50 copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H5619-143 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$50 and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-143 (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleaning, and other preventive services with no copay. Medicare dental services require a $50 copay, and fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan also covers restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 with prior authorization and a doctor referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment benefits are covered, including durable medical equipment with 20% coinsurance and no copay, prosthetics and medical supplies with 20% coinsurance and no copay, and diabetic equipment with varying coinsurance and copay amounts. 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, Diagnostic Procedures/Tests with a copay between $0 and $55, and Lab Services with no copay. Radiological Services include coverage for Diagnostic and Therapeutic Radiological Services and Outpatient X-Ray Services, with a copay of up to $375 for Diagnostic Radiological Services, and a coinsurance of at least 20% for Therapeutic Radiological Services.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-143 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-143 (HMO) does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H5619-143 (HMO) with a doctor referral and prior authorization. You will pay a $10 copay for days 1-20, a $214 copay for days 21-50, and no copay for days 51-100; additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H5619-143 (HMO) plan covers acupuncture with a $50 copay, and covers a meal benefit with no copay. Other services such as over-the-counter 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, and Self-Directed Personal Assistance Services are not covered.
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