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Humana Gold Plus Giveback H5619-150 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H5619-150 (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 H5619-150 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus Giveback H5619-150 (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 Giveback H5619-150 (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 H5619-150 (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 H5619-150 (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 $57.00. 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 $5000.00 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 H5619-150 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. For preferred generic drugs at a standard pharmacy, there is no copay, while standard mail order has a $20 copay. For standard generic drugs, the copay is $30 at a standard pharmacy and $47 via standard mail order. For preferred brand drugs, you pay 35% coinsurance, and for non-preferred drugs, you pay 30% coinsurance.
Additional Benefits
The Humana Gold Plus Giveback H5619-150 (HMO) plan offers a variety of benefits, including coverage for inpatient hospital stays with a $250 copay for the first five days, and no copay for days 6-90. Outpatient services have copays ranging from $0 to $250, while emergency services have a $120 copay. This plan also covers primary care with no copay, along with hearing, vision, and dental services. Hearing exams have a $30 copay, while routine eye exams have no copay. Dental services have a $750 annual maximum, and include no copay for many services.
Inpatient Hospital See details
Inpatient Hospital coverage includes a $250 copay for days 1-5, and no copay for days 6-90 for acute care, and a $250 copay for days 1-5, and no copay for days 6-90 for psychiatric care. Additional days for inpatient hospital-acute are covered with no copay for days 91-999. Non-Medicare-covered stay and upgrades for inpatient hospital-acute, and additional days and non-Medicare-covered stay for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services includes coverage for all outpatient hospital services, with a copay ranging from $0 to $250, and observation services with a $250 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a copay between $30 and $100 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $55 copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus Giveback H5619-150 (HMO) plan. Ground ambulance services have a $300 copay, and air ambulance services have a $1250 copay, but there is no coinsurance for either. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay and no coinsurance, Urgently Needed Services have a $55 copay and no coinsurance, and Worldwide Emergency Services have a $120 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Gold Plus Giveback H5619-150 (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $10 copay. Occupational therapy services have a $15 copay, and physician specialist services have a $30 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $15 copay. Additional telehealth benefits have a copay between $0 and $55, and Opioid Treatment Program Services have a copay between $30 and $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus Giveback H5619-150 (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.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, and routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay; prescription hearing aids (all types) are covered with a copay between $499 and $799 for two per year, but other prescription hearing aid types and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $30, while routine eye exams have no copay. Eyewear, including contact lenses and eyeglasses, has no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $750 annual maximum. Medicare Dental Services have a $30 copay. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus Giveback H5619-150 (HMO) plan, but require prior authorization and a doctor's referral. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus Giveback H5619-150 (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered; Prosthetics/Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a maximum copay of $100, and lab services, with no copay. Radiological Services include coverage for all services, with a maximum copay of $200 for diagnostic services, a 20% coinsurance for therapeutic services, and no copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus Giveback H5619-150 (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 not covered by the Humana Gold Plus Giveback H5619-150 (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus Giveback H5619-150 (HMO) plan, but require prior authorization and a doctor's referral. For days 1-20, the copay is $10, and for days 21-100, the copay is $203.
Other Services See details
Under Other Services, acupuncture is covered with a $30 copay, but is limited to 20 treatments per year and requires prior authorization. Other services such as Over-the-Counter (OTC) Items, Meal Benefit, 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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