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Humana Gold Plus SNP-DE H5619-167 (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 H5619-167 (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 H5619-167 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H5619-167 (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 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H5619-167 (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 H5619-167 (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 H5619-167 (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 H5619-167 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.20. 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 H5619-167 (HMO D-SNP) plan has a prescription drug deductible of $590.00. If you qualify for the low-income subsidy (LIS), you will pay $26.20. After the deductible, you will pay the costs for your drugs until your total drug costs reach $2000.00. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays can cost up to $2,185 per admission, while outpatient services and many specialist visits have a 20% coinsurance. The plan includes no copay for preventive services, routine hearing exams, eye exams, and many dental services. This plan also offers additional benefits such as coverage for hearing aids, vision services, and dental services with varying cost-sharing. Transportation to health-related locations is covered with no copay, and there is a $1500 maximum benefit for over-the-counter items. Emergency services have a $110 copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered with prior authorization and a doctor's referral. For Inpatient Hospital-Acute, the copay for a Medicare-covered stay is $2,185 per admission or stay, and additional days are unlimited with no copay. For Inpatient Hospital Psychiatric, the copay for a Medicare-covered stay is $2,036 per admission or stay. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute and Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services and Observation Services with a 20% coinsurance, Ambulatory Surgical Center (ASC) Services, and Outpatient Substance Abuse Services with a minimum 20% and maximum 20% coinsurance. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $315 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, up to 24 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a 20% coinsurance with a maximum per visit amount of $45. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) plan covers primary care physician services with a 20% coinsurance. Chiropractic services are covered with no copay, but routine care is not covered. Occupational therapy services, physician specialist services, physical therapy, and speech-language pathology services are covered with a 20% coinsurance. Mental health and psychiatric services are covered with a 20% coinsurance for individual and group sessions. Additional telehealth benefits are covered with no copay and a 20% coinsurance. Opioid treatment program services are covered with a coinsurance of 20%.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and additional preventive services, kidney disease education services, and other preventive services with no copay. Health education, in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, and enhanced disease management, telemonitoring services, remote access technologies (including Web/Phone-based technologies and Nursing Hotline), home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a coinsurance of at most 20% for routine hearing exams. Fitting/evaluation for hearing aids has no copay. Prescription Hearing Aids are covered with a maximum benefit of $2500 per year, and prescription hearing aids (all types) have no copay. Over-the-counter hearing aids are covered with a $0 copay, with a maximum benefit of $2500 per year for both ears combined.
Vision Services See details
The Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear with no copay and a combined maximum benefit of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance, and other dental services with a $3,000 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, prosthodontics, fixed, and oral and maxillofacial surgery are covered with no copay, while fluoride treatment, maxillofacial prosthetics, implants, 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 H5619-167 (HMO D-SNP) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Medical Supplies, is covered under this plan. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies also have a 20% coinsurance. Diabetic Equipment is covered, with coinsurance and copayments for some services, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a coinsurance of at most 20%, and lab services with no copay and a coinsurance of at most 20%. Therapeutic Radiological Services, Diagnostic Radiological Services, and Outpatient X-Ray Services are covered with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H5619-167 (HMO 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 not in practice since Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. A referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, requiring prior authorization and a doctor's referral. For days 1-20 and 66-100, there is no copay, while days 21-65 have a $214 copay.
Other Services See details
Other Services includes acupuncture with 20% coinsurance and a limit of 20 treatments per year, over-the-counter (OTC) items with a $1500 maximum benefit, and a meal benefit with no copay. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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.
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