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Humana Gold Plus H5619-152 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-152 (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 H5619-152 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-152 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-152 (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 H5619-152 (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 H5619-152 (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 $3.00. 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 $350.00 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 $9350.00 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 H5619-152 (HMO) plan has a $350 deductible for prescription drugs. In the initial coverage phase, after the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the standard pharmacy, you will pay no copay for preferred generic drugs, a $47 copay for standard generic drugs, and 48% coinsurance for preferred brand drugs. After 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 H5619-152 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $399 copay for days 1-6, and then no copay for the rest of the stay. Outpatient services, primary care, and preventive services often have no copay, while services like specialist visits, hearing exams, and dental services have low copays. The plan also includes coverage for ambulance services with a $315 copay, emergency services with a $110 copay, and hearing aids with a copay between $399 and $699. Additionally, the plan covers home health services with no copay, and skilled nursing facility stays with a $0 copay for the first 20 days and a $214 copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered with a copay of $399 for days 1-6, and no copay for days 7-90, and no coinsurance. Additional days for Inpatient Hospital-Acute are covered with no copay, and no coinsurance for days 91-999. 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 includes coverage for Outpatient Hospital Services with a copay between $0 and $450, Observation Services with a $399 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay between $45 and $100, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-152 (HMO) plan. Ground and Air Ambulance Services each have a $315 copay, with no coinsurance, while Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay with no coinsurance, Urgently Needed Services have a $45 copay with no coinsurance, and Worldwide Emergency Services have a $110 copay with no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Gold Plus H5619-152 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, and physician specialist services with a $15 copay. Mental health specialty services have a $45 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a copay between $0 and $45, and Opioid Treatment Program Services have a copay between $45 and $100. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, counseling services. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit, all with no copay.
Hearing Services See details
The Humana Gold Plus H5619-152 (HMO) plan covers hearing exams with a $15 copay, and routine hearing exams with no copay. The plan also covers fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $399 and $699, but inner ear, outer ear, and over-the-ear hearing aids are not covered. The plan also covers OTC hearing aids up to $25 every three months.
Vision Services See details
The Humana Gold Plus H5619-152 (HMO) plan covers vision services, including eye exams with a copay of $0-$15, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-152 (HMO) plan covers Medicare Dental Services with a $15 copay, and other dental services with a $2,000 maximum. Oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are covered with no copay, while fluoride treatment, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
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%. 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 by the Humana Gold Plus H5619-152 (HMO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment is covered under the Humana Gold Plus H5619-152 (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, while Diabetic Supplies have a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with copays between $0 and $120 for diagnostic procedures/tests, and no copay for lab services. Radiological Services include copays for diagnostic and therapeutic services, with a maximum copay of $325 for diagnostic services and $25 for therapeutic services, as well as a 20% coinsurance for therapeutic services; outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-152 (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 under the Humana Gold Plus H5619-152 (HMO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-152 (HMO) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Plus H5619-152 (HMO) plan covers acupuncture with a $15 copay and a limit of 20 treatments per year, and also covers over-the-counter items with a maximum benefit of $25 every three months. This plan also covers meal benefits with no copay. However, this plan does not cover Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other services.
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