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Humana Gold Plus Giveback H5619-146 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H5619-146 (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 Giveback H5619-146 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H5619-146 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Los Angeles and Orange Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus Giveback H5619-146 (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 Giveback H5619-146 (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 Giveback H5619-146 (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 $102.00. 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 $2450.00 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 Giveback H5619-146 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay different copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you'll pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy, while standard generic drugs have a $34 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus Giveback H5619-146 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that range from $0 to $250. Emergency services, including worldwide coverage, have a $140 copay. Primary care, preventive, and home health services have no copay. Hearing, vision, and dental services have copays ranging from $0 to $25, and some services have a maximum annual benefit. The plan also covers medical equipment, diagnostic services, and other services with copays or coinsurance, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with prior authorization and a doctor referral required. For Inpatient Hospital-Acute, there is a $175 copay for days 1-5, and no copay for days 6-90, with additional days 91-999 having no copay. Inpatient Hospital Psychiatric has a $900 copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $250, observation services with a $175 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $10 copay for individual or group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan with a $10 copay, and requires prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground Ambulance Services have a $200 copay, and Air Ambulance Services have a 20% coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have varying costs. Emergency Services have a $140 copay and no coinsurance, Urgently Needed Services have a $10 copay and no coinsurance, and Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $140 copay and no coinsurance.
Primary Care See details
The Humana Gold Plus Giveback H5619-146 (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. You will have no copay for primary care physician services, chiropractic services, occupational therapy services, physical therapy, and speech-language pathology services. You will have a $25 copay for physician specialist services, and copays ranging from $10 to $25 for mental health, psychiatric, and opioid treatment services.
Preventive Services See details
Preventive services, including annual physical exams, are covered with no copay. Some additional preventive services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have a copay between $99 and $399, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus Giveback H5619-146 (HMO) plan offers vision services including eye exams with a copay between $0 and $25. Eyewear is covered with a $0 copay, with a combined maximum plan benefit of $300 per year. Contact lenses and eyeglasses (lenses and frames) are covered with a $0 copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus Giveback H5619-146 (HMO) plan covers Medicare Dental Services with a $25 copay, and other dental services with a $1,750 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus Giveback H5619-146 (HMO) plan, but require prior authorization and a doctor's referral. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 19% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance; Diabetic Equipment is covered, with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $25, and lab services with no copay. Radiological services include a copay of up to $75 for diagnostic services and a coinsurance of at least 20% for therapeutic services, while outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus Giveback H5619-146 (HMO) plan with no copay and no coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Gold Plus Giveback H5619-146 (HMO) plan, but all sub-services are not covered. 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 Gold Plus Giveback H5619-146 (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $150 copay for days 21-100; there is no coinsurance. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus Giveback H5619-146 (HMO) plan covers acupuncture with a $25 copay, but is limited to 20 treatments per year and requires prior authorization. Other services such as over-the-counter items, meal benefits, and many other services are not covered.
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