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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 2025, 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 3.5 out of 5 stars in 2025.
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 $4.00. 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 $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 H5619-171 (HMO) plan has a $450 deductible for prescription drugs. Once the deductible is met, you will pay a copay or coinsurance depending on the tier and pharmacy used. For example, if you use a standard pharmacy, you will pay a $0 copay for preferred generic drugs, a $47 copay for standard generic drugs, 40% coinsurance for preferred brand drugs, and 27% coinsurance for non-preferred drugs. After your total drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-171 (HMO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0 to $450. Emergency, primary care, and preventive services are covered, often with no copay. The plan includes coverage for hearing, vision, and dental services, often with no copay for routine services. Additional benefits include ambulance, home health, and skilled nursing facility services, as well as coverage for home infusion, dialysis, and medical equipment. Diagnostic, radiological, and cardiac rehabilitation services are covered, with some services requiring a copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered, with a copay of $394 for days 1-6 (acute) or 1-5 (psychiatric), and no copay for days 7-90 (acute) or 6-90 (psychiatric). Additional days for acute care are covered with no copay, while non-Medicare-covered stays and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $450, observation services with a $394 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $45 and $100 for individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for all services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-171 (HMO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Gold Plus H5619-171 (HMO) plan. Ground and Air Ambulance Services each have a copay of $315, with no coinsurance. 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. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and all have no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-171 (HMO) plan covers primary care physician services with no copay, and chiropractic services with a $15 copay. Occupational therapy services have a $25 copay, while specialist visits have a $30 copay. Mental health and psychiatric services have a $45 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits have a copay between $0 and $45. Opioid treatment program services have a minimum copay of $45 and a maximum copay of $100. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include a variety of services, with an annual physical exam covered with no copay. Additional preventive services, kidney disease education services, and other preventive services are covered with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams have no copay for one exam per year. Fitting/evaluation for hearing aids also has no copay. Prescription hearing aids are covered, with a copay between $399 and $699 for all types of prescription hearing aids (2 per year), but not for prescription hearing aids for the inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H5619-171 (HMO) plan covers vision services, including routine eye exams with a copay of $0, and eyewear with a copay of $0. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-171 (HMO) plan covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, all with no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Gold Plus H5619-171 (HMO) plan, requiring prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-171 (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 11% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment with varying copays and coinsurance depending on the specific supply. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required for all diagnostic and radiological services. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $120, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, and Therapeutic Radiological Services have a maximum copay of $30 and a minimum coinsurance of 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H5619-171 (HMO) 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 the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H5619-171 (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H5619-171 (HMO) plan covers acupuncture with a $30 copay per visit, up to 20 treatments per year, and meal benefits with no copay. Over-the-counter items, 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 are not covered.
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