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Humana Gold Plus H5619-147 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-147 (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 H5619-147 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-147 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Napa and Marin. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-147 (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 H5619-147 (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 H5619-147 (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 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 $3200.00 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 H5619-147 (HMO) Medicare plan offers an Enhanced Alternative drug benefit with a $615 annual prescription drug deductible. After meeting this deductible, you enter the initial coverage phase where Tier 1 preferred generics cost as low as a $1 copay, and Tier 2 standard generics require a $33 copay at standard pharmacies and preferred mail orders. Tier 3 preferred brands and Tier 4 non-preferred drugs require a 50% and 25% coinsurance, respectively, until total drug costs reach $2,100. Once your annual out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy, also known as Extra Help, will have no copay for their Part D prescriptions.
Additional Benefits
The Humana Gold Plus H5619-147 (HMO) plan offers robust coverage for everyday medical needs, featuring no copay and no coinsurance for primary care, specialist visits, physical therapy, and routine preventive services. For hospital care, patients pay a $390 copay per admission for inpatient stays and up to a $200 copay for outpatient hospital services, both with no coinsurance. Emergency care is available with a $150 copay, which is waived if admitted, while urgent care requires a $65 copay. This plan also includes key supplemental benefits, such as dental coverage up to $2,500 annually and routine vision care up to $300 annually, both with no copay or coinsurance for most services. Routine hearing exams and over-the-counter hearing aids are also covered with no copay, while prescription hearing aids require copays between $599 and $899. Additionally, patients can access home health services, acupuncture, and over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-147 (HMO) partially covers inpatient hospital services, requiring a $390 copay per admission and no coinsurance for covered acute and psychiatric stays, both of which require prior authorization. While unlimited additional days for acute stays are covered with no copay, upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-147 (HMO) covers outpatient services with no coinsurance, featuring copays of $0 to $200 for outpatient hospital services and $25 to $35 for substance abuse sessions. Patients will pay a $390 copay per stay for observation services, while ambulatory surgical center and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Humana Gold Plus H5619-147 (HMO) covers partial hospitalization benefits with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Humana Gold Plus H5619-147 (HMO), offering ground ambulance services for a $335 copay and air ambulance services for a $1,250 copay, both with no coinsurance. Prior authorization is required for ambulance services, while transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H5619-147 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services each require a $150 copay and no coinsurance.
Primary Care See details
Primary care, specialist, physical therapy, and occupational therapy services are covered by Humana Gold Plus H5619-147 (HMO) with no copay and no coinsurance. Mental health, psychiatric, telehealth, and opioid treatment services are also covered with copays ranging up to $65 and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Humana Gold Plus H5619-147 (HMO) with no copay and no coinsurance for services such as annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, and memory fitness. However, additional preventive benefits are only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, bathroom modifications, and counseling services are not covered.
Hearing Services See details
Humana Gold Plus H5619-147 (HMO) covers routine hearing exams, fitting evaluations, and over-the-counter hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $599 to $899 and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-147 (HMO) partially covers vision services, offering routine eye exams and eyewear, such as contact lenses and eyeglasses (lenses and frames), with no copay or coinsurance up to a $300 annual limit. Individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered by Humana Gold Plus H5619-147 (HMO) up to a maximum of $2,500 annually, featuring no copays and no coinsurance for most covered care, though fixed prosthodontics requires a 30% coinsurance and no copay. This benefit is partially covered, as fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-147 (HMO) covers home infusion bundled services with prior authorization, requiring no copay and coinsurance ranging from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus H5619-147 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H5619-147 (HMO) covers medical equipment with prior authorization, including durable medical equipment at a 15% coinsurance and no copay, and prosthetic devices at a 20% coinsurance. Diabetic supplies require a 10% coinsurance with no copay, while diabetic therapeutic shoes and inserts require a $10 copay with no coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-147 (HMO) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic procedures have a copay of $0 to $65 and diagnostic radiological services have a copay of up to $300, both with no coinsurance. Lab services and outpatient X-rays have no copay or coinsurance, while therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H5619-147 (HMO) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-147 (HMO) does not cover Cardiac Rehabilitation Services, as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-147 (HMO) partially covers Skilled Nursing Facility (SNF) services with prior authorization, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coinsurance. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-147 (HMO) covers acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, but does not cover meal benefits or Dual Eligible SNPs. Acupuncture is limited to 20 treatments per year with prior authorization, and OTC items are available through reimbursement.
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