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Humana Dual Select H5619-165 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Dual Select H5619-165 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Dual Select H5619-165 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Dual Select H5619-165 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in WA. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Dual Select H5619-165 (HMO 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 Dual Select H5619-165 (HMO 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 Dual Select H5619-165 (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.
For Humana Dual Select H5619-165 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.00. 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 $615.00 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 Dual Select H5619-165 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, you will pay no copay when filling prescriptions at a standard pharmacy or through preferred mail order. However, utilizing standard mail order for these generic medications results in a copay of $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 drugs, the plan requires a 25% coinsurance. This 25% coinsurance applies across standard pharmacies, preferred mail order, and standard mail order options. The coinsurance rate covers both 1-month and 3-month supplies, with Tier 5 specialty medications restricted to a 1-month supply.
Additional Benefits
The Humana Dual Select H5619-165 (HMO D-SNP) offers robust coverage with affordable cost-sharing, including no copays or coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a low $30 copay, while inpatient hospital stays feature a $300 copay for the first six days and no copay for days seven through 90. Outpatient hospital services range from no copay up to a $295 copay with 20% coinsurance, and emergency care is covered with a $115 copay. This plan also features valuable supplemental benefits, such as no copays or coinsurance for routine vision exams and dental care up to a $1,500 annual limit. Additionally, members pay no copay for routine hearing exams, fitting evaluations, and over-the-counter hearing aids, alongside receiving up to 26 free one-way transportation trips per year. For medical equipment and dialysis, there is no copay and a standard 20% coinsurance.
Inpatient Hospital See details
Humana Dual Select H5619-165 (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, featuring a $300 copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Dual Select H5619-165 (HMO D-SNP) covers outpatient hospital services with a copay of $0 to $295 and 20% coinsurance, and observation services with a $300 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Dual Select H5619-165 (HMO D-SNP) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Dual Select H5619-165 (HMO D-SNP), featuring a $335 copay and no coinsurance for ground ambulance services and a 20% coinsurance with no copay for air ambulance services. Transportation services are partially covered with no copay and no coinsurance for up to 26 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Dual Select H5619-165 (HMO D-SNP) covers emergency services with a $115 copay, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered under the plan with a $115 copay and no coinsurance.
Primary Care See details
Humana Dual Select H5619-165 (HMO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Most therapy, psychiatric, and mental health services require a $35 copay and no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by Humana Dual Select H5619-165 (HMO D-SNP) with no copay and no coinsurance for covered care such as annual physicals, smoking cessation, memory fitness, and disease screenings. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Humana Dual Select H5619-165 (HMO D-SNP) with no coinsurance, featuring a $30 copay for Medicare-covered exams and no copay for annual routine exams, fitting evaluations, and unlimited OTC hearing aids. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Dual Select H5619-165 (HMO D-SNP) partially covers vision services with no coinsurance and no copays, though prior authorization is required. The plan covers one routine eye exam and one pair of contact lenses or eyeglasses per year up to a $150 limit, but other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Dual Select H5619-165 (HMO D-SNP) partially covers dental services up to a $1,500 annual limit, offering most preventive and comprehensive services with no copay and no coinsurance, while Medicare-covered dental services require a $30 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Dual Select H5619-165 (HMO D-SNP) with no copay, although prior authorization and step therapy may apply. Covered Medicare Part B drugs, including chemotherapy and insulin, range from no coinsurance to 20% coinsurance, with insulin copays capped at $35.
Dialysis Services See details
Dialysis services are covered by Humana Dual Select H5619-165 (HMO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Humana Dual Select H5619-165 (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic services with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Dual Select H5619-165 (HMO D-SNP) covers diagnostic and radiological services, with prior authorization required. Diagnostic procedures carry a $0 to $40 copay and 20% coinsurance, therapeutic radiology requires a copay and 20% coinsurance, and outpatient x-rays and diagnostic radiology feature no copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Dual Select H5619-165 (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Dual Select H5619-165 (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization, where some services are covered, but specific sub-services are not covered. Specifically, Cardiac Rehabilitation Services and Intensive Cardiac Rehabilitation Services (each with 20% coinsurance), as well as Pulmonary Rehabilitation Services and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services (each with 8% coinsurance), are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Humana Dual Select H5619-165 (HMO D-SNP) with no coinsurance, as additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 to 20 and 66 to 100, a $218 daily copay for days 21 to 65, and prior authorization is required.
Other Services See details
Humana Dual Select H5619-165 (HMO D-SNP) covers other services with no copay and no coinsurance, including acupuncture up to 25 treatments per year, over-the-counter items, and meal benefits for chronic illnesses. Prior authorization is required for acupuncture and meals, and some other services in this category are not covered.
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