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Humana Gold Plus H5619-174 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-174 (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 H5619-174 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-174 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in WA. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-174 (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 H5619-174 (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 H5619-174 (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.
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 $200.00 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 $5900.00 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 H5619-174 (HMO) plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, featuring no copay for a 3-month supply through preferred mail order and a low $10 copay for a 1-month supply at standard pharmacies. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, which can be filled at standard pharmacies or via mail order. For more specialized medications, Tier 4 non-preferred drugs carry a 48% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply. These clear copayment and coinsurance structures help you easily estimate your out-of-pocket prescription drug costs.
Additional Benefits
The Humana Gold Plus H5619-174 (HMO) plan offers robust coverage with no copay for primary care visits, preventive services, and home health care. Specialist visits require a $40 copay, while inpatient hospital stays carry a $450 daily copay for the first five days and no copay thereafter. Emergency room services are available with a $130 copay, and urgent care visits require a $50 copay. Supplemental benefits include routine vision and dental care with no copay, featuring a $250 annual limit for eyewear and up to $2,000 for dental services. Routine hearing exams and over-the-counter hearing aids also have no copay, though prescription hearing aids require a copay of $699 to $999. For durable medical equipment and dialysis services, members will pay no copay and a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-174 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $450 daily copay for days 1 to 5 and no copay for days 6 and beyond. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-174 (HMO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from no copay to $450 (with a $450 copay per stay for observation services), and outpatient substance abuse sessions range from no copay to a $35 copay.
Partial Hospitalization See details
Humana Gold Plus H5619-174 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-174 (HMO) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, with no coinsurance and prior authorization required for both. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H5619-174 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-174 (HMO) offers primary care, mental health specialty, and psychiatric services with no copay and no coinsurance. Specialist visits require a $40 copay, physical and occupational therapy require a $45 copay, and telehealth services range from a $0 to $50 copay, all with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H5619-174 (HMO) covers preventive services, including annual physicals, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are partially covered with no coinsurance, offering memory fitness with no copay and alternative therapies for a $20 copay, while services like health education, nutritional therapy, and weight management are not covered.
Hearing Services See details
Humana Gold Plus H5619-174 (HMO) hearing services include Medicare-covered exams for a $40 copay and routine exams and fitting evaluations for no copay, all with no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Vision Services are partially covered by the Humana Gold Plus H5619-174 (HMO) plan, offering no coinsurance, no deductibles, and no copays for one routine eye exam and one pair of eyeglasses or contact lenses per year up to a $250 limit. Other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered under this plan.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-174 (HMO), offering up to $2,000 annually for most preventive and comprehensive care with no copay and no coinsurance, while Medicare-covered dental services require a $40 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-174 (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization and step therapy. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H5619-174 (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H5619-174 (HMO) covers durable medical equipment, prosthetics, and medical supplies with 20% coinsurance and no copay. Diabetic supplies are covered with 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 H5619-174 (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures have a $0 to $50 copay and no coinsurance, lab services have no copay and no coinsurance, and radiological services range from no copay for X-rays to a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H5619-174 (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 H5619-174 (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-174 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. Patients pay a $10 daily copay for days 1 through 20, a $218 daily copay for days 21 through 50, and no copay for days 51 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Humana Gold Plus H5619-174 (HMO) covers acupuncture with a $20 copay and no coinsurance for up to 25 treatments per year with prior authorization. Over-the-counter items and chronic illness meal benefits are also covered with no copay and no coinsurance, though meals require prior authorization.
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