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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 2025, 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 3.5 out of 5 stars in 2025.
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. Additionally, this plan comes with a Part B Premium reduction of $3.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
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 has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred mail order pharmacies and a $20 copay at standard mail order pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you may have reduced costs for your prescriptions. Be sure to check the plan's formulary for specific drug coverage details.
Additional Benefits
The Humana Gold Plus H5619-174 (HMO) plan offers a wide array of benefits, including coverage for inpatient and outpatient services. You'll pay a copay for inpatient hospital stays, with no copay for days 5-90. Outpatient services have varying copays and coinsurance depending on the specific service. This plan also includes coverage for emergency services, primary care, preventive services, and various therapies with copays ranging from $0 to $125. It provides benefits for hearing, vision, and dental services, with varying copays. Additionally, the plan covers medical equipment, diagnostic services, and home health services with a combination of copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For the first 4 days, the copay is $395 per admission, and days 5-90 have no copay. Additional days for Inpatient Hospital-Acute have no copay for days 91-999. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional days for Inpatient Hospital Psychiatric 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, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a 20% coinsurance and a copay between $0 and $350, while Observation Services have a $395 copay. Ambulatory Surgical Center Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have a 20% coinsurance and a copay between $5 and $5.
Partial Hospitalization See details
Partial Hospitalization is covered with a $80 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-174 (HMO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $1250 copay, and there is no coinsurance for either service. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. For Emergency Services and Worldwide Emergency Coverage, the copay is $125, and for Urgently Needed Services, the copay is $55. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $125 copay. There is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H5619-174 (HMO) plan offers primary care services with no copay, and covers chiropractic services with a $20 copay. Occupational therapy services have a $45 copay, and physician specialist services have a $40 copay. Mental health and psychiatric individual and group sessions have no copay, while physical therapy and speech-language pathology services have a $45 copay. Additional telehealth benefits range from no copay to a $55 copay, and opioid treatment program services have a 20% coinsurance and a $5 copay.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services with copays for fitness and alternative therapies. Additional services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay and routine hearing exams have no copay. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids (all types) have a copay between $699 and $999, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H5619-174 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$40, and eyewear with no copay, up to a combined maximum of $150 per year. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-174 (HMO) plan covers Medicare Dental Services with a $40 copay, and other dental services with no copay. 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 are covered 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 and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-174 (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Equipment. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus H5619-174 (HMO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $55, and lab services with no copay. Diagnostic radiological services have a copay of at most $350, and therapeutic radiological services have a coinsurance of at least 20%. Outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-174 (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. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H5619-174 (HMO) plan. For days 1-20, there is a $10 copay, for days 21-50 there is a $214 copay, and for days 51-100, there is no copay.
Other Services See details
Other Services include acupuncture and a meal benefit. Acupuncture has a $20 copay per visit, and the plan covers up to 25 treatments per year. The meal benefit has no copay.
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