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Humana Gold Plus H5619-172 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-172 (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 H5619-172 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-172 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Kentucky. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-172 (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 H5619-172 (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 H5619-172 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $11.00. 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 $6750.00 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 H5619-172 (HMO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For preferred generic drugs, you may pay a $5 copay at preferred pharmacies and through mail order, or a $20 copay at standard pharmacies. For standard generic drugs, the copay is $47. For preferred brand drugs, you will pay 38% coinsurance.
Additional Benefits
The Humana Gold Plus H5619-172 (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. This plan also covers primary care, specialist visits, and mental health services with copays. The plan includes coverage for ambulance services, emergency care, and hearing exams, and vision services. Dental services are also covered, with no copay for many services, but with coinsurance for restorative and prosthodontic procedures. Additionally, the plan covers home infusion, dialysis, medical equipment, and diagnostic services with copays or coinsurance, and skilled nursing facility stays with a copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 5 days of an inpatient stay, you will pay a $450 copay, and days 6-90 have no copay; additional days for Inpatient Hospital-Acute have no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $450, while Observation Services have a $450 copay. Ambulatory Surgical Center Services and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services have a copay between $30 and $80 for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H5619-172 (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services are covered, with a $315 copay for both ground and air ambulance services, and 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 by the Humana Gold Plus H5619-172 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services have a $55 copay, and all services have no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-172 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay (prior authorization required), and occupational therapy services with a $20-$35 copay (prior authorization required). The plan also covers physician specialist services with a $30 copay, mental health specialty services with a $30 copay, and physical therapy and speech-language pathology services with a $20-$35 copay (prior authorization required). Additionally, the plan covers telehealth services with a $0-$55 copay and Opioid Treatment Program Services with a $30-$80 copay (prior authorization required). Podiatry Services are not covered.
Preventive Services See details
Preventive services include no copay for Medicare-covered services, annual physical exams, and fitness benefits, but other services like health education, in-home safety assessments, and counseling services are not covered. Additional preventive services, kidney disease education services, and other preventive services have a copay, but the specific amount is not listed.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams are covered with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types, but not for inner ear, outer ear, or over-the-ear hearing aids. OTC hearing aids are covered, with a maximum plan benefit of $30 every three months.
Vision Services See details
The Humana Gold Plus H5619-172 (HMO) plan covers vision services including eye exams and eyewear. Eye exams have a copay of $0 to $30, while eyewear has no copay, and a combined maximum plan benefit coverage of $300.
Dental Services See details
The Humana Gold Plus H5619-172 (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 (fixed), and oral and maxillofacial surgery. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery have no copay, but restorative services and prosthodontics (fixed) have 30% - 40% coinsurance. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-172 (HMO) plan, but require prior authorization. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 19% coinsurance, Prosthetics/Medical Supplies with 19% coinsurance, and Diabetic Equipment. Diabetic Supplies have no copay and a 10-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and lab services with a copay of $0-$105, and outpatient x-ray services with no copay. Diagnostic Radiological Services have a copay of at most $720, and Therapeutic Radiological Services have a copay of at most $30 and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-172 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus H5619-172 (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-172 (HMO) plan, with a prior authorization requirement. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H5619-172 (HMO) plan covers acupuncture with a $30 copay, and also covers over-the-counter items with a $30 maximum benefit every three months. The plan also covers a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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