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Humana Gold Plus H5619-148 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-148 (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 H5619-148 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-148 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Central/Southern California Area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-148 (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 H5619-148 (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 H5619-148 (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $2900.00 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 H5619-148 (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, a preferred generic drug has a $5 copay at a standard pharmacy, while a standard generic drug has a $40 copay. For preferred brand drugs, you'll pay 50% coinsurance, and for non-preferred drugs, you'll pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-148 (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with a $125 copay. The plan also covers a variety of services with no copay, such as primary care, preventive services, hearing exams, vision services, and many dental services. Additional benefits include ambulance and transportation services, home health services, and skilled nursing facility stays with copays. The plan also covers medical equipment with coinsurance, and diagnostic and radiological services with copays or coinsurance. Note that prior authorization and doctor referrals are often required for many of these services.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $150 copay for days 1-5, and no copay for days 6-90, while 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 $100, Observation Services with a $150 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $15 and $100 for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization and a doctor referral are required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-148 (HMO) plan, but requires prior authorization and a doctor referral. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-148 (HMO) plan. Medicare-covered ground ambulance services have a $300 copay, and air ambulance services have a $1250 copay, with no coinsurance for either.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Services, are covered by the Humana Gold Plus H5619-148 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgent Care has a $10 copay; all services have no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-148 (HMO) plan covers primary care physician services, physician specialist services, and physical/speech therapy with no copay. Chiropractic services have a $10 copay, while individual and group mental health/psychiatric sessions have a $15 copay. Additional telehealth benefits have a copay between $0 and $15, and opioid treatment program services have a copay between $15 and $100. Occupational therapy services require authorization and a referral, but have no copay. Podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus H5619-148 (HMO) plan covers preventive services, including an annual physical exam with no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and several other services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams and routine hearing exams have no copay, and fitting/evaluation for hearing aids also has no copay; however, prescription hearing aids have a copay between $699 and $999, depending on the type of aid. Prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H5619-148 (HMO) plan covers vision services including routine eye exams, contact lenses, and eyeglasses (lenses and frames) with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $1,500 annual maximum benefit. Medicare Dental Services have no copay, and other dental services such as Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), and Other Preventive Dental Services have no copay. Restorative Services and Prosthodontics (fixed) have a 30-40% coinsurance, and Oral and Maxillofacial Surgery has no copay. Fluoride Treatment, Prosthodontics (removable), 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 a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-148 (HMO) plan and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits for Humana Gold Plus H5619-148 (HMO) include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies have a 10% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $100, Lab Services with no copay, Diagnostic Radiological Services with a maximum copay of $150, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with no copay. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-148 (HMO) plan with no copay and no coinsurance. 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 H5619-148 (HMO) plan, but the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-148 (HMO) plan. For days 1-20, the copay is $20, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H5619-148 (HMO) plan covers acupuncture with no copay, but it requires prior authorization and is limited to 20 treatments per year. The plan also covers a meal benefit with no copay. 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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