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Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Indiana. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP).
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 SNP-DE H5619-158 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $48.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $590.00 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 SNP-DE H5619-158 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you will enter the next coverage phase. If you qualify for the low-income subsidy, you'll pay $48 per month for Part D.
Additional Benefits
The Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP) plan offers a wide array of benefits, including inpatient and outpatient services, with varying cost-sharing. You'll pay a copay for inpatient hospital stays, ambulance, and emergency services, while many other services like home health and preventive care have no copay. This plan also covers dental, hearing, and vision services with a yearly maximum for eyewear and a $4,000 maximum benefit for dental. Additionally, the plan includes coverage for medical equipment, diagnostic services, and other services like acupuncture and over-the-counter items, with a maximum of $1200 per year for OTC items.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization required. For Inpatient Hospital-Acute, there is a copay of $2185 per admission or stay, and for Inpatient Hospital Psychiatric, there is a copay of $2036 per admission or stay. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, 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 and Observation Services with 20% coinsurance, Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services with a 20% coinsurance, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by this plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered with no coinsurance, and a copay of $315 for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered, with no copay, for up to 24 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a 20% coinsurance.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Chiropractic Services are partially covered, with Routine Chiropractic Care not covered, and Occupational Therapy Services, Individual and Group Sessions for Mental Health and Psychiatric Services, and Opioid Treatment Program Services are covered with a minimum 20% and maximum 20% coinsurance. Additional Telehealth Benefits are covered with a 20% coinsurance and no copay. Podiatry Services are not covered.
Preventive Services See details
The Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, including Additional Sessions of Smoking and Tobacco Cessation Counseling and Fitness Benefit, with no copay.
Hearing Services See details
Hearing services include routine hearing exams with no copay and a coinsurance of at most 20%, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, and a maximum benefit of $500 per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include coverage for eye exams and eyewear, with a 20% coinsurance for eye exams and eyewear, and no copay for eye exams, contact lenses, and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan offers a combined maximum of $500 per year for eyewear.
Dental Services See details
Dental services are covered, including Medicare and other dental services, with a $4,000 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but some services have visit limits. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts. Diabetic Supplies have a 20% coinsurance and no copay. Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a coinsurance of at most 20%, and lab services with no copay and a coinsurance of at most 20%. Diagnostic radiological services have a copay of at most $325 and a coinsurance of at most 20%, therapeutic radiological services have a coinsurance of at most 20%, and outpatient X-ray services have a $50 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H5619-158 (HMO-POS D-SNP) 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 the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, 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 stays for SNF are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a 20% coinsurance, and the meal benefit has no copay. The plan provides up to $1200 per year for OTC items. However, 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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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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