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Humana Gold Plus SNP-DE H5619-168 (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 H5619-168 (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 H5619-168 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H5619-168 (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 H5619-168 (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 H5619-168 (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 H5619-168 (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 H5619-168 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.20. 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 H5619-168 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible, you will pay the costs for your drugs based on the specific tier and pharmacy you use until your total drug costs reach $2000. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you pay nothing for covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy, with a monthly Part D premium of $24.20.
Additional Benefits
The Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) plan offers a wide range of benefits with varying costs. Hospital stays have a copay of $1986 per admission, with some outpatient services requiring a 20% coinsurance. Emergency services have a $100 copay, while ambulance services have a copay of $315 for ground transport and a 20% coinsurance for air transport. Preventive services, hearing exams, and many dental services have no copay, while vision exams have a 20% coinsurance. The plan also covers a variety of other services, including home health, skilled nursing, and cardiac rehabilitation, with specific copays or coinsurance depending on the service. Additionally, the plan covers over-the-counter items with a maximum benefit, acupuncture, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $1986 per admission or stay; however, additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a 20% coinsurance, while Ambulatory Surgical Center Services and Outpatient Substance Abuse Services have a 20% coinsurance. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus SNP-DE H5619-168 (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, including all ambulance services and transportation services to a plan-approved health-related location. Ground ambulance services have a $315 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay, and are limited to 24 one-way trips per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) plan. Emergency Services have a $100 copay, while Urgently Needed Services have a 20% coinsurance. Worldwide Emergency, Urgent Coverage, and Transportation each have a $100 copay.
Primary Care See details
The Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) plan covers primary care services with a 20% coinsurance, chiropractic services with no copay, occupational therapy services with a 20% coinsurance, and physician specialist services with a 20% coinsurance. The plan also covers mental health specialty services, including individual and group sessions with a 20% coinsurance, and offers additional telehealth benefits with no copay and a 20% coinsurance. Additionally, the plan covers physical therapy and speech-language pathology services with a 20% coinsurance.
Preventive Services See details
The Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs after a welcome visit, are also covered with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services include hearing exams and prescription hearing aids. Routine hearing exams have no copay and a coinsurance of at most 20%, with one exam covered every year, while fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have no copay, with two aids covered every three years, while inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a 20% coinsurance and no copay, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered, and there is a $100 combined maximum plan benefit for eyewear per year.
Dental Services See details
Dental Services are covered, with a $3,500 annual maximum. Medicare Dental Services require prior authorization and a doctor referral and have a 20% coinsurance, while 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 have no copay. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, are covered with a coinsurance of 0% to 20%, and a $35 copay for Medicare Part B Insulin Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) plan, but require prior authorization and a doctor referral. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 20% coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts. Diabetic Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered. Diagnostic procedures/tests have a coinsurance of at most 20%, while lab services have a coinsurance of at most 20% and no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $150, and outpatient X-ray services have a coinsurance of at most 20% and a copay of $50.
Home Health Services See details
Home Health Services are covered 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 the plan does not cover the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) plan, with a doctor referral and prior authorization required. You will have no copay for days 1-20, a $214 copay for days 21-65, and no copay for days 66-100.
Other Services See details
The Humana Gold Plus SNP-DE H5619-168 (HMO D-SNP) plan covers acupuncture with no copay, but requires prior authorization and is limited to 25 treatments per year. Over-the-counter items are covered with a maximum benefit of $1980 per year, and the plan offers nicotine replacement therapy as a Part C OTC benefit. The plan also covers a meal benefit with no copay. Several other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others are not covered.
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