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Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H5619-166 (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 Gold Plus SNP-DE H5619-166 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H5619-166 (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 Gold Plus SNP-DE H5619-166 (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 Gold Plus SNP-DE H5619-166 (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 Gold Plus SNP-DE H5619-166 (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 Gold Plus SNP-DE H5619-166 (HMO D-SNP), 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.
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 $235.00 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 SNP-DE H5619-166 (HMO D-SNP) has an annual drug deductible of $235. For Tier 1 preferred generics and Tier 2 generics, there is no copay for one-month and three-month supplies at standard pharmacies and preferred mail order. If you use standard mail order, you will pay a $10 copay for Tier 1 and a $20 copay for Tier 2 one-month supplies. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs require a 25% coinsurance for both one-month and three-month supplies across standard pharmacies and mail-order options. Specialty medications in Tier 5 carry a 30% coinsurance for a one-month supply at standard pharmacies and mail-order services.
Additional Benefits
The Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) offers comprehensive coverage with predictable cost-sharing, generally featuring no copay and a 20% coinsurance for outpatient care, primary and specialist visits, dialysis, and durable medical equipment. For inpatient hospital stays, members pay a set copay per stay with no coinsurance, while emergency services require a $115 copay with no coinsurance. Additionally, home health services, preventive care, and up to 24 one-way transportation trips are fully covered with no copay and no coinsurance. Supplemental benefits under this plan include routine dental care up to a $2,000 annual maximum, as well as over-the-counter hearing aids and routine vision hardware, all available with no copay and no coinsurance. Routine hearing and vision exams are also covered with no copay and a 20% coinsurance. Finally, skilled nursing facility stays require no coinsurance and feature no copay for the first 20 days, though a daily copay applies for days 21 through 65.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. While unlimited additional acute care days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) are covered with no copay and a 20% coinsurance, with prior authorization required. This coverage includes outpatient hospital visits, ambulatory surgical center services, outpatient substance abuse sessions, and outpatient blood services.
Partial Hospitalization See details
Partial hospitalization benefits are covered under Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) covers ground ambulance services with a $335 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a 20% coinsurance (up to $40) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) covers primary care, specialist, therapy, and mental health services with no copay and 20% coinsurance. Podiatry services are not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive Services are partially covered by Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) with no copay and no coinsurance for covered services, including annual physical exams, glaucoma screenings, diabetes self-management training, memory fitness, and tobacco cessation counseling. While many essential screenings are included at no cost, several supplemental services like health education, nutritional therapy, and in-home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) hearing services include routine exams once yearly with a 20% coinsurance and no copay, alongside OTC hearing aids and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two aids every three years, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) features partially covered vision services with no deductible, offering one routine eye exam per year with no copay and a 20% coinsurance. Eyewear is also partially covered with no copay, no coinsurance, and a $100 annual limit for one pair of contact lenses or eyeglasses, though standalone lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP), with Medicare-covered dental services requiring no copay and a 20% coinsurance. Other covered preventive and comprehensive dental services have no copay and no coinsurance up to a $2,000 annual maximum, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) covers Home Infusion bundled Services subject to prior authorization and step therapy. Covered Medicare Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance, other Part B drugs have no copay and no coinsurance to 20% coinsurance, and chemotherapy drugs require a copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required before receiving these services.
Medical Equipment See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic services, with a 20% coinsurance and no copay. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP), generally requiring prior authorization and a 20% coinsurance. Members pay no copay for lab services and diagnostic tests, while diagnostic radiological services require a $200 copay in addition to the 20% coinsurance.
Home Health Services See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) offers Cardiac Rehabilitation Services with no copay and prior authorization, although some services are not covered in practice. Specifically, cardiac rehabilitation and intensive cardiac rehabilitation (each requiring 20% coinsurance), as well as pulmonary rehabilitation and supervised exercise therapy for peripheral artery disease (each requiring 15% coinsurance), are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) 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 1–20 and 66–100, a $218 daily copay for days 21–65, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by Humana Gold Plus SNP-DE H5619-166 (HMO D-SNP) include acupuncture with no copay and 20% coinsurance, and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are partially covered with no copay and no coinsurance, excluding certain drugs on the CMS OTC list.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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