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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 2026, 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 out of 5 stars in 2026.
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 $615.00 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 $8850.00 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) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing as little as a $5 copay for a 1-month supply, or no copay for a 3-month supply when using preferred mail order. For Tier 3 preferred brand drugs, copays start at $47 for a 1-month supply, with savings available on 3-month supplies through preferred mail order. Higher tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 45% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. Choosing standard mail order services generally results in higher copays across all tiers.
Additional Benefits
The Humana Gold Plus H5619-173 (HMO) plan offers affordable healthcare coverage, featuring no copays or coinsurance for primary care visits, annual preventive screenings, and home health services. Specialist visits require a $45 copay, while inpatient hospital stays require a $550 daily copay for the first few days and no copay for subsequent days. Emergency care is available with a $115 copay, which is waived upon hospital admission, and urgent care has a $40 copay. Supplemental benefits include routine vision and hearing exams with no copay, plus up to $1,000 in dental coverage with no copay or coinsurance. Standard diagnostic lab tests and outpatient X-rays also carry no copay, while durable medical equipment and dialysis services require a 20% coinsurance. Skilled nursing facilities are covered with no copay for the first 20 days, followed by a $218 daily copay.
Inpatient Hospital See details
Inpatient hospital services are covered by Humana Gold Plus H5619-173 (HMO) with no coinsurance, requiring a $550 daily copay for days 1 through 4 of acute stays and days 1 through 3 of psychiatric stays, with no copay for subsequent days. While unlimited additional acute days are covered with no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-173 (HMO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services, and a $35 copay for outpatient substance abuse sessions. Outpatient hospital services have no coinsurance with copays ranging from no copay up to $550, while outpatient observation services require a $550 copay per stay.
Partial Hospitalization See details
Humana Gold Plus H5619-173 (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
Humana Gold Plus H5619-173 (HMO) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, subject to prior authorization. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Humana Gold Plus H5619-173 (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 are available with 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 H5619-173 (HMO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $45 copay and no coinsurance. Physical, occupational, and mental health therapies have a $35 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Humana Gold Plus H5619-173 (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, memory fitness, and Medicare-covered screenings. This benefit is partially covered because health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H5619-173 (HMO), featuring a $45 copay and no coinsurance for Medicare-covered exams, while routine exams, fitting evaluations, and OTC hearing aids have no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999 for up to two devices per year, though inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Vision Services are partially covered by Humana Gold Plus H5619-173 (HMO), offering no coinsurance and copays ranging from no copay to $45 for covered eye exams, which includes one annual routine exam with no copay. Covered eyewear has no copay and no coinsurance up to a $100 annual limit, but other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-173 (HMO) partially covers dental services, offering up to a $1,000 annual maximum for most preventive and comprehensive care with no copay and no coinsurance, while Medicare-covered dental services require a $45 copay and no coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H5619-173 (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy and other drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-173 (HMO) plan with no copay and 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment covered by Humana Gold Plus H5619-173 (HMO) includes durable medical equipment, prosthetics, and medical supplies, which generally require 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 H5619-173 (HMO) covers diagnostic and radiological services, offering no copay for lab tests and outpatient X-rays, and no coinsurance for diagnostic procedures. Diagnostic tests have copays ranging from no copay up to $105, diagnostic radiology copays start at no copay, and therapeutic radiology requires a minimum 20% coinsurance and a $40 copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H5619-173 (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Humana Gold Plus H5619-173 (HMO) feature no coinsurance and a $10 copay with prior authorization, but some services are covered in practice as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-173 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus H5619-173 (HMO), featuring acupuncture for a $45 copay and no coinsurance, and over-the-counter items and chronic illness meals with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while the Other 1, Other 2, and Other 3 sub-services are not covered.
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