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Humana Gold Plus H5619-157 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-157 (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 H5619-157 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-157 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Richmond-Tidewater 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 H5619-157 (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 H5619-157 (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 H5619-157 (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 H5619-157 (HMO) plan has a $350 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, for a 30-day supply, you will pay a $5 copay at a standard pharmacy for preferred generic drugs, but 50% coinsurance for preferred brand drugs. Once 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 H5619-157 (HMO) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $450, and emergency services with a $110 copay. This plan also covers primary care with no copay, and specialist services with a $40 copay. Additional benefits include hearing exams with a $40 copay, vision care with routine eye exams and eyewear covered, and dental services with no copay for many services, up to an annual maximum. The plan also covers home health services and skilled nursing facilities with varying copays, along with other services like acupuncture and a meal benefit.
Inpatient Hospital See details
Inpatient hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $399 for days 1-6, and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $399 for days 1-5, and no copay for days 6-90 for Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay, while 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 include 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, Outpatient Substance Abuse services with a copay between $45 and $100 for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-157 (HMO) plan, but requires prior authorization. There is a $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by the Humana Gold Plus H5619-157 (HMO) plan, with a $315 copay for both ground and air ambulance services, and no coinsurance. 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 under the Humana Gold Plus H5619-157 (HMO) plan. Emergency services have a $110 copay, and urgently needed services have a $45 copay; both have no coinsurance. Worldwide emergency services, including worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation, each have a $110 copay, with no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-157 (HMO) plan offers primary care services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $25 copay. Additionally, the plan covers physician specialist services with a $40 copay, and mental health, psychiatric, and opioid treatment program services with a copay ranging from $45 to $100. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay between $0 and $45.
Preventive Services See details
Preventive Services are covered, including an annual physical exam with no copay. Fitness benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit all have no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay, while routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, with a copay between $399 and $699 for all types of prescription hearing aids except for inner ear, outer ear, and over the ear hearing aids, which are not covered. OTC hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-157 (HMO) covers vision services, including routine eye exams with a copay between $0 and $40, and eyewear with no copay, up to a combined maximum of $150 per year. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-157 (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic services, cleaning, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, each with a $0 copay; however, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan has an annual maximum benefit of $1,000 for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H5619-157 (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while 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 under the Humana Gold Plus H5619-157 (HMO) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment coverage under the Humana Gold Plus H5619-157 (HMO) plan includes Durable Medical Equipment (DME) with a 12% coinsurance and Prosthetics/Medical Supplies with no copay and a 20% coinsurance for Medicare-covered items. Diabetic Supplies have no copay and a 10-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus H5619-157 (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $120, and lab services with no copay. Radiological services are covered, with a maximum copay of $325 for diagnostic services, a maximum copay of $40 and 20% coinsurance for therapeutic services, and no copay for outpatient x-ray services.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-157 (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, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and copay information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-157 (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, which has a $40 copay, and 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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