Humana Gold Plus SNP-DE H5619-163 (HMO D-SNP)

Humana Gold Plus SNP-DE H5619-163 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Kentucky. This plan received an overall rating of 3 out of 5 stars in 2026.

It's important to know that Humana Gold Plus SNP-DE H5619-163 (HMO D-SNP) 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 SNP-DE H5619-163 (HMO 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.

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:

Drug Coverage

The Humana Gold Plus SNP-DE H5619-163 (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for 1-month and 3-month fills at standard pharmacies and through preferred mail order. However, standard mail order for these generic tiers requires a copay ranging from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty medications, you will pay a 25% coinsurance. This 25% coinsurance applies to standard pharmacies, preferred mail order, and standard mail order for both 1-month and 3-month supplies, with Tier 5 specialty drugs limited to a 1-month supply. This straightforward cost-sharing structure helps you easily plan for your monthly prescription expenses.

Additional Benefits

The Humana Gold Plus SNP-DE H5619-163 (HMO D-SNP) offers comprehensive medical coverage, featuring no copays for primary care, specialists, and outpatient services, though these generally require a 20% coinsurance. Inpatient hospital stays require a copay of $2,230 for acute care and $2,080 for psychiatric care, while emergency room visits carry a $115 copay and ambulance services require a $335 copay. Skilled nursing facility care has no copay for the first 20 days, and home health services are fully covered with no copay and no coinsurance. This plan also provides robust ancillary benefits, including up to $3,000 annually for preventive and comprehensive dental services with no copay or coinsurance, and up to $350 yearly for eyewear with no copay and no coinsurance. Routine hearing exams, prescription hearing aids, annual physicals, and over-the-counter items are all available with no copay, helping to minimize out-of-pocket expenses. Additionally, members can access up to 48 one-way routine transportation trips and acupuncture treatments with no copay, though coinsurance or prior authorization may apply to certain services.