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Humana Gold Plus H5619-173 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-173 (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 H5619-173 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-173 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Bowling Green 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 H5619-173 (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 H5619-173 (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 H5619-173 (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 $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 H5619-173 (HMO) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $5 copay at preferred mail order pharmacies and $20 copay at standard mail order pharmacies. For standard generic drugs, you will pay a $47 copay, and for preferred brand drugs, you will pay 38% coinsurance.
Additional Benefits
The Humana Gold Plus H5619-173 (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays depending on the specific service. The plan also provides coverage for primary care, preventive, hearing, vision, and dental services, with some services having no copay. Other benefits include ambulance, emergency, and home health services, as well as coverage for medical equipment and diagnostic services. This plan provides coverage for many services with copays, coinsurance, and prior authorization requirements. Some of the services covered include ambulance, emergency, and home health services, as well as coverage for medical equipment and diagnostic services. However, there are exclusions for additional services like routine hearing exams, and certain dental services like orthodontics.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $550 copay for days 1-4 and no copay for days 5-90, with no coinsurance, and for Additional Days, there is no copay and no coinsurance for days 91-999. Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you will pay a $550 copay for days 1-3 and no copay for days 4-90, with no coinsurance. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $550, and observation services with a $550 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, while Outpatient Substance Abuse Services have a copay between $45 and $90 for both individual and group sessions.
Partial Hospitalization See details
Partial hospitalization is covered under the Humana Gold Plus H5619-173 (HMO) plan and requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-173 (HMO) plan. Ground and Air Ambulance Services 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 under the Humana Gold Plus H5619-173 (HMO) plan. Emergency Services has a $110 copay, and Urgently Needed Services has a $45 copay; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, with no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-173 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy with a $35 copay, physician specialist services with a $45 copay, and mental health specialty services with a $45 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $35 copay, additional telehealth benefits have a copay between $0 and $45, and opioid treatment program services have a copay between $45 and $90. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services. Annual physical exams have no copay, and some additional services like the fitness benefit, and kidney disease education services have no copay. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing Services under the Humana Gold Plus H5619-173 (HMO) plan include hearing exams with a $45 copay, but routine hearing exams and fitting/evaluation for hearing aids are not covered. Prescription hearing aids are not covered, and OTC hearing aids are covered with a maximum plan benefit of $25 every three months for both ears combined.
Vision Services See details
The Humana Gold Plus H5619-173 (HMO) plan covers vision services, including eye exams and eyewear. Eye exams have a copay of $0-$45, while routine eye exams have no copay. Eyewear has no copay, with a combined maximum plan benefit coverage amount of $100 per year.
Dental Services See details
Dental services include a $45 copay for Medicare dental services. Other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. This plan does not cover fluoride treatments, endodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-173 (HMO) plan and require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by this plan. DME has a 20% coinsurance, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have a 10-20% coinsurance, with a $0 copay for Diabetic Supplies, and a $10 copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests (with a copay between $0 and $105), and lab services with no copay. Outpatient X-ray services have no copay, while diagnostic and therapeutic radiological services have a copay of up to $525 and $40, and therapeutic radiological services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-173 (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Humana Gold Plus H5619-173 (HMO) plan, but the specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-173 (HMO) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes acupuncture with a $45 copay, up to 20 treatments per year, and over-the-counter (OTC) items with a $25 maximum benefit every three months. The plan also covers meal benefits with no copay. However, this plan does not cover 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.
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