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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 2026, 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 out of 5 stars in 2026.
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 $1.00. 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 $7200.00 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 features an annual prescription drug deductible of $350. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay for one-month and three-month supplies at standard pharmacies or through preferred mail order. However, standard mail order for these generic tiers requires a copay ranging from $10 to $60 depending on the tier and supply duration. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, while a three-month supply costs $141 at standard pharmacies or a reduced $131 through preferred mail order. For Tier 4 non-preferred drugs, members pay a 48% coinsurance for both one-month and three-month supplies across all fulfillment channels. Tier 5 specialty drugs carry a 29% coinsurance for a one-month supply, with no three-month supply option available.
Additional Benefits
The Humana Gold Plus H5619-152 (HMO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care visits, home health services, and routine preventive care. Specialist visits require a low $15 copay, while emergency room care has a $115 copay that is waived if you are admitted to the hospital. For hospital stays, inpatient acute care requires a $375 daily copay for the first seven days and no copay thereafter, with outpatient hospital services ranging from no copay up to a $450 copay. This plan also features valuable supplemental benefits, including routine dental, vision, and hearing exams with no copay. Prescription hearing aids are covered with copays between $399 and $699, and covered eyewear has no copay up to a $150 annual limit. Additionally, over-the-counter items are covered with no copay, while durable medical equipment requires a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus H5619-152 (HMO) covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays require a $375 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays incur a $375 daily copay for days 1-5 and no copay for days 6-90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-152 (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $450 for outpatient hospital services, $375 per stay for observation services, and $35 for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, with prior authorization required for these outpatient services.
Partial Hospitalization See details
Humana Gold Plus H5619-152 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-152 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H5619-152 (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-152 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Therapy services require a $25 copay, mental health and psychiatric sessions require a $35 copay, and telehealth benefits range from a $0 to $40 copay, all with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under the Humana Gold Plus H5619-152 (HMO) plan are partially covered with no copay and no coinsurance for services such as annual physical exams, kidney disease education, glaucoma screenings, and memory fitness. However, several supplemental benefits are not covered, including health education, in-home safety assessments, medical nutrition therapy, weight management programs, and home-based palliative care.
Hearing Services See details
Humana Gold Plus H5619-152 (HMO) covers hearing services, featuring a $15 copay and no coinsurance for Medicare-covered exams, while routine exams, fitting evaluations, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $399 to $699 and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Humana Gold Plus H5619-152 (HMO) partially covers vision services with no coinsurance, offering routine eye exams with no copay and other covered exams with a copay up to $15. Covered eyewear has no copay and no coinsurance up to a $150 annual limit, but other eye exam services, separate lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-152 (HMO) dental services are partially covered, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $2,000 annual limit. Fluoride treatment, maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H5619-152 (HMO) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%. Covered Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Humana Gold Plus H5619-152 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H5619-152 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-152 (HMO) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $120 copay, while radiological services range from no copay for X-rays to a minimum $15 copay and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H5619-152 (HMO) plan with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H5619-152 (HMO) with no coinsurance and require prior authorization, though some services are not covered, including standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy for PAD ($20 copay).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H5619-152 (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-152 (HMO) partially covers other services, offering acupuncture for a $15 copay and no coinsurance, as well as over-the-counter items and meal benefits with no copay and no coinsurance. Other miscellaneous services and dual-eligible SNP benefits are not covered under this plan.
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