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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 2026, 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 out of 5 stars in 2026.
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 $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 $9250.00 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) prescription drug plan features an annual drug deductible of $350. Tier 1 preferred generic drugs have no copay for both 1-month and 3-month supplies at standard pharmacies and preferred mail order. Tier 2 generic drugs cost a $5 copay for a 1-month supply, but you will pay no copay for a 3-month supply through preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply at standard pharmacies and mail order options. Tier 4 non-preferred drugs require a 45% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a 1-month supply. This structure helps you estimate your out-of-pocket expenses based on your specific medication tier and pharmacy choice.
Additional Benefits
The Humana Gold Plus H5619-157 (HMO) plan offers comprehensive medical coverage with no copays and no coinsurance for primary care doctor visits, preventive services, home health care, and cardiac rehabilitation. For inpatient hospital stays, members pay a $375 daily copay for the first six days of acute stays and no copay for subsequent days. Specialized outpatient care and mental health services are available with a $35 copay, while emergency room visits carry a $115 copay that is waived upon admission. This plan also features valuable dental, vision, and hearing benefits to help reduce out-of-pocket expenses. Members enjoy no copays for preventive and comprehensive dental services up to a $1,500 annual limit, alongside routine hearing exams at no cost. Prescription hearing aids and eyewear are partially covered with low-to-no copays, and durable medical equipment is available with a standard 20 percent coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H5619-157 (HMO) covers inpatient hospital services with no coinsurance, requiring a $375 daily copay for days 1-6 of acute stays (no copay for days 7-999) and days 1-5 of psychiatric stays (no copay for days 6-90). Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-157 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H5619-157 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-157 (HMO) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H5619-157 (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 are covered with 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 H5619-157 (HMO) features primary care physician visits with no copay and no coinsurance, while specialist and mental health services require a $35 copay and no coinsurance. Physical and occupational therapies have a $25 copay with no coinsurance, but podiatry is not covered, and only some chiropractic services are covered since routine and other chiropractic services are excluded.
Preventive Services See details
Preventive Services under Humana Gold Plus H5619-157 (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Additional preventive services are partially covered, offering a fitness benefit with no copay and no coinsurance, while services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus H5619-157 (HMO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance, while Medicare-covered exams require a $35 copay and no coinsurance. Hearing aids are partially covered with no coinsurance and copays ranging from $0 to $599 for up to two prescription hearing aids every three years, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Humana Gold Plus H5619-157 (HMO) partially covers vision services, offering eye exams with a $0 to $35 copay and no coinsurance, alongside eyewear up to a $350 annual limit with no copay and no coinsurance. Prior authorization is required, and other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-157 (HMO) dental services are partially covered, requiring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and comprehensive services up to a $1,500 annual maximum. Fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-157 (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance with no copay, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H5619-157 (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H5619-157 (HMO), with durable medical equipment, prosthetics, and medical supplies requiring 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 and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H5619-157 (HMO) with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and copays ranging from no copay to $120 for procedures. Radiological services vary from no copay for X-rays (coinsurance applies) and diagnostic radiology to a minimum 20% coinsurance and $35 copay for therapeutic radiology.
Home Health Services See details
Home health services are covered by Humana Gold Plus H5619-157 (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Humana Gold Plus H5619-157 (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-157 (HMO) partially covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-157 (HMO) partially covers other services, providing acupuncture with a $35 copay, no coinsurance, and prior authorization for up to 20 treatments per year. Over-the-counter (OTC) items and meal benefits are not covered under this plan.
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