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Humana Gold Plus H5619-171 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-171 (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 H5619-171 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-171 (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 H5619-171 (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 H5619-171 (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 H5619-171 (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 $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 $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 H5619-171 (HMO) prescription drug plan has an annual drug deductible of $450. Under this plan, there is no copay for Tier 1 preferred generics and Tier 2 generics when using a standard pharmacy or preferred mail order for 1-month and 3-month supplies. If you choose standard mail order, Tier 1 drugs have a $10 copay and Tier 2 drugs have a $20 copay for a 1-month supply. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, or up to a $141 copay for a 3-month supply depending on your pharmacy choice. Tier 4 non-preferred drugs require a 47% coinsurance, and Tier 5 specialty drugs require a 27% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H5619-171 (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth services, and routine preventive care. Specialist visits require a $30 copay, while emergency room care is subject to a $115 copay that is waived if you are admitted within 24 hours. For hospitalizations, inpatient acute stays require a $345 daily copay for the first seven days, after which there is no copay. Supplemental benefits are a highlight of this plan, featuring dental coverage with no copay up to a $3,000 annual maximum and routine vision care with no copay up to a $250 eyewear limit. Additionally, members pay no copay for routine hearing exams, home health services, or the first 20 days of a skilled nursing facility stay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Humana Gold Plus H5619-171 (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays require a $345 daily copay for days 1-7 and no copay for days 8 and beyond, whereas psychiatric stays require a $345 daily copay for days 1-5 and no copay for days 6-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-171 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay of $0 to $450, observation services require a $345 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Humana Gold Plus H5619-171 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H5619-171 (HMO), featuring a $335 copay and no coinsurance for both ground and air ambulance trips, which require prior authorization. While some transportation services are covered, trips to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H5619-171 (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, with none of these services subject to a plan-level deductible.
Primary Care See details
Humana Gold Plus H5619-171 (HMO) offers primary care physician and telehealth services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Physical and occupational therapy cost a $25 copay, mental health and psychiatric sessions require a $35 copay, and chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H5619-171 (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs, with no copay and no coinsurance. Additional preventive services are partially covered, offering a memory fitness benefit with no copay and no coinsurance, while sub-services including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, remote access technologies, home safety devices, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H5619-171 (HMO) covers hearing services with no coinsurance, offering routine hearing exams and fitting evaluations for no copay, and Medicare-covered exams for a $30 copay. Prescription hearing aids are partially covered with a copay between $499 and $799 and no coinsurance, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-171 (HMO) offers partially covered vision services with no deductible and no coinsurance, featuring a $0 to $30 copay for eye exams (no copay for routine exams) and no copay for eyewear. Covered eyewear includes contact lenses or eyeglasses up to a $250 annual limit, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-171 (HMO) up to a $3,000 annual maximum, with a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services. Fluoride treatments, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-171 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, insulin, and other drugs require a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H5619-171 (HMO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Humana Gold Plus H5619-171 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-171 (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic services carry no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $120 copay. Radiological services feature outpatient X-rays with no copay but applicable coinsurance, diagnostic radiology with copays starting at $0, and therapeutic radiology with a minimum $30 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-171 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H5619-171 (HMO) with no coinsurance and require prior authorization, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, which otherwise feature copays ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-171 (HMO) 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 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Humana Gold Plus H5619-171 (HMO) partially covers other services, offering acupuncture with a $30 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Both covered services require prior authorization, while over-the-counter (OTC) items are not covered.
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