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Humana Gold Plus Giveback H5619-169 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H5619-169 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus Giveback H5619-169 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H5619-169 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus Giveback H5619-169 (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus Giveback H5619-169 (HMO).
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 Giveback H5619-169 (HMO), 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 $119.00. 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 $450.00 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 Giveback H5619-169 (HMO) plan features an annual drug deductible of $450. For Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. Standard mail order options are also available for these lower tiers, with copays ranging from $10 to $20 for a one-month supply. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, with three-month preferred mail orders reduced to $131. Higher-tier medications require coinsurance instead of flat copays, with Tier 4 non-preferred drugs carrying a 40% coinsurance and Tier 5 specialty drugs requiring 27% coinsurance. These cost-sharing details help you easily estimate your out-of-pocket prescription costs under this Humana HMO plan.
Additional Benefits
The Humana Gold Plus Giveback H5619-169 (HMO) plan provides affordable coverage for core medical services, featuring no copay and no coinsurance for primary care doctor visits and a $40 copay for specialists. Inpatient hospital stays require a $375 daily copay for the first 5 to 7 days depending on the stay type, with no copay for subsequent days. Emergency room visits carry a $115 copay, which is waived upon admission, while urgent care services require a $40 copay. For supplemental care, the plan offers no copay for preventive services, routine dental cleanings, and routine eye exams, alongside a $150 annual allowance for eyewear. Prescription hearing aids are covered with copays ranging from $699 to $999, and skilled nursing care is available with no copay for the first 20 days. Home health services are also fully covered with no copay or coinsurance, helping to keep out-of-pocket costs low.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Gold Plus Giveback H5619-169 (HMO) with no coinsurance, requiring a $375 daily copay for days 1-7 of acute stays (no copay for days 8 and beyond) and days 1-5 of psychiatric stays (no copay for days 6-90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H5619-169 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus Giveback H5619-169 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H5619-169 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus Giveback H5619-169 (HMO) 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 require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus Giveback H5619-169 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Other covered services include physical, occupational, and speech therapies for a $25 copay, mental health and psychiatric services for a $35 copay, and telehealth for a $0 to $40 copay, all with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus Giveback H5619-169 (HMO) provides partial coverage for preventive services with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. However, several additional preventive services are not covered under this plan, including fitness benefits, health education, personal emergency response systems, weight management programs, and in-home safety assessments.
Hearing Services See details
Humana Gold Plus Giveback H5619-169 (HMO) covers Medicare-covered hearing exams for a $40 copay, and routine exams and fitting evaluations with no copay, all with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $699 and $999 for up to two aids per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by the Humana Gold Plus Giveback H5619-169 (HMO) plan, featuring no deductibles, no coinsurance, and copays ranging from $0 to $40 for eye exams. Covered routine exams and eyewear have no copay up to a $150 annual limit, though other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Giveback H5619-169 (HMO) offers partially covered dental services with a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care like cleanings and oral exams. While many restorative and surgical services are covered with no copay and no coinsurance, fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H5619-169 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Part B drugs, including chemotherapy and radiation, have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin drugs carry a $35 copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus Giveback H5619-169 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus Giveback H5619-169 (HMO) covers durable medical equipment with a 19% coinsurance and no copay, and prosthetic devices and medical supplies with a 20% coinsurance and no copay for non-Medicare benefits. Covered diabetic supplies feature a 10% to 20% coinsurance with no copay, while diabetic therapeutic shoes or inserts carry a $10 copay, with prior authorization required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the Humana Gold Plus Giveback H5619-169 (HMO) plan, with prior authorization required. Diagnostic tests feature no coinsurance and a $0 to $120 copay, while lab services have no copay and no coinsurance. Outpatient X-rays and diagnostic radiology have a $0 minimum copay, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $40 copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus Giveback H5619-169 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus Giveback H5619-169 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation (with a $30 copay), intensive cardiac rehabilitation (with a $30 copay), pulmonary rehabilitation (with a $25 copay), and supervised exercise therapy for symptomatic peripheral artery disease (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H5619-169 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a 3-day inpatient hospital stay is not required prior to admission, additional days beyond the standard 100-day limit are not covered.
Other Services See details
Humana Gold Plus Giveback H5619-169 (HMO) provides partial coverage for other services, excluding over-the-counter (OTC) items. Covered benefits include acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and meal benefits with no copay and no coinsurance.
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