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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 2026, 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 out of 5 stars in 2026.
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 $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. You must continue to pay paying your reduced 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 $550.00 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 H5619-167 (HMO D-SNP) prescription drug plan features an annual drug deductible of $550. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for one-month or three-month supplies at standard pharmacies and through preferred mail order. If you use standard mail order for these generic tiers, copays range from $10 to $20 for a one-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand and Tier 4 non-preferred drugs require a 25% coinsurance for both one-month and three-month fills. Tier 5 specialty drugs carry a 26% coinsurance for a one-month supply across all available pharmacy and mail order channels.
Additional Benefits
The Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) plan offers comprehensive medical coverage with a mix of copays and coinsurance depending on the service. For inpatient hospital stays, members pay a $2,230 copay per acute care stay with no coinsurance, while outpatient hospital services, primary care, and specialist visits generally require no copay and a 20% coinsurance. Additionally, preventive services, home health care, and select routine benefits like acupuncture and over-the-counter items are available with no copay and no coinsurance. This plan also features valuable supplemental benefits, including dental coverage up to a $3,000 annual limit with no copay and no coinsurance for covered preventive and comprehensive services. Vision and hearing benefits include routine exams with no copay and 20% coinsurance, alongside allowances for eyewear and hearing aids at no copay or coinsurance. For urgent and emergency needs, emergency room visits carry a $115 copay, while members can access up to 24 one-way trips per year to approved health locations with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and while unlimited additional acute care days are covered with no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) covers outpatient services with no copay, though a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, substance abuse, and blood services. Prior authorization is required for these covered services, and there is no deductible for outpatient blood services.
Partial Hospitalization See details
Partial hospitalization services are covered under the Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) covers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while rides to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to $40 per visit) 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 H5619-167 (HMO D-SNP) covers primary care, specialist visits, telehealth, therapy, and mental health services with no copay and a 20% coinsurance. Chiropractic and podiatry services are not covered under this plan, and prior authorization is required for most specialty care.
Preventive Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) partially covers preventive services with no copay and no coinsurance for covered options like annual physical exams, kidney disease education, glaucoma screenings, diabetes training, and select smoking cessation counseling. However, various supplemental benefits such as health education, nutritional programs, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services covered by Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) include one annual routine exam with no copay and 20% coinsurance, and unlimited fitting evaluations with no copay. Prescription hearing aids are partially covered with no copay or coinsurance for up to two aids every three years, excluding inner ear, outer ear, and over the ear types, while over-the-counter hearing aids are covered with no copay or coinsurance.
Vision Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) provides partially covered vision services with no deductibles, offering one annual routine eye exam with no copay and a 20% coinsurance, though other eye exams are not covered. Eyewear is also partially covered with no copay or coinsurance up to a $200 annual limit for one pair of eyeglasses or contact lenses, but individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) offers partially covered dental services up to a $3,000 annual limit, featuring no copay and a 20% coinsurance for Medicare-covered dental services, and no copay and no coinsurance for other covered preventive and comprehensive services. Specifically, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) covers home infusion bundled services with prior authorization and step therapy. Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, chemotherapy drugs require no coinsurance to 20% coinsurance, and other Part B drugs feature no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment covered by Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) includes durable medical equipment, prosthetics, medical supplies, and diabetic supplies, all featuring a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, though prior authorization is required and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services covered by Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) require prior authorization and generally carry a 20% coinsurance. Diagnostic procedures, tests, and lab services have no copay, while diagnostic and therapeutic radiological services require copays, including a $200 copay for diagnostic radiology.
Home Health Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay and prior authorization required, though several services are not covered in practice. Specifically, standard cardiac rehabilitation (20% coinsurance), intensive cardiac rehabilitation (20% coinsurance), pulmonary rehabilitation (8% coinsurance), and supervised exercise therapy for peripheral artery disease (8% coinsurance) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 66 to 100, while days 21 to 65 require a $218 copayment.
Other Services See details
Humana Gold Plus SNP-DE H5619-167 (HMO D-SNP) covers other services including acupuncture, over-the-counter (OTC) items, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for the meal benefit and acupuncture, which is limited to 25 treatments per year, while certain other services in this category are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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