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Humana Gold Plus H5619-175 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-175 (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 H5619-175 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-175 (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 H5619-175 (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 H5619-175 (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 H5619-175 (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 $2.00. 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 $150.00 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 H5619-175 (HMO) plan has a $150 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you'll pay a $5 copay at preferred pharmacies and $20 at standard mail pharmacies. For preferred brand drugs, you'll pay 45% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus H5619-175 (HMO) plan offers a variety of benefits with varying costs. This plan covers inpatient hospital stays with a copay, outpatient services with coinsurance and copays, and emergency services with a copay. Primary care visits have a $10 copay, and preventive services, including an annual physical exam, have no copay. Additional benefits include coverage for hearing and vision services, with copays for exams and hearing aids, and no copay for eyewear. Dental services, home health services, and many other services are also covered with no copay. However, some services, like cardiac rehabilitation and certain types of medical equipment, may have coinsurance or require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered under the Humana Gold Plus H5619-175 (HMO) plan. For Inpatient Hospital-Acute, you'll pay a $495 copay for days 1-5, and no copay for days 6-90, with additional days 91-999 having no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you'll pay a $458 copay for days 1-5, and no copay for days 6-90, with additional days and non-Medicare stays not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a 20% coinsurance and a copay between $0 and $495, as well as observation services with a $495 copay. Ambulatory Surgical Center (ASC) Services have no copay, while Outpatient Substance Abuse Services, Individual Sessions, and Group Sessions each have a 20% coinsurance and no copay. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $85 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-175 (HMO) plan. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a $1250 copay, and there is no coinsurance for either. 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. Emergency Services have a $125 copay, and Urgently Needed Services have a $55 copay, and all Worldwide Emergency Services have a $125 copay, with no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-175 (HMO) plan covers Primary Care Physician Services with a $10 copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $45 copay, and Physical Therapy and Speech-Language Pathology Services with a $35 copay. Mental Health and Psychiatric Services, including individual and group sessions, have no copay. Additional Telehealth Benefits have a copay between $0 and $55, and Opioid Treatment Program Services have a 20% coinsurance and no copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Humana Gold Plus H5619-175 (HMO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and an EKG following a Welcome Visit with no copay. However, health education, in-home safety assessments, and other services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $45 copay, while routine hearing exams have no copay, and fitting/evaluation for hearing aids also have no copay; prescription hearing aids (all types) have a copay between $699 and $999, while OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H5619-175 (HMO) plan covers vision services, including routine eye exams with a copay of $0-$45, and eyewear with a $0 copay, up to a combined maximum of $100 per year. However, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-175 (HMO) plan offers 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 (removable and fixed), and oral and maxillofacial surgery with no copay. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered, and there is a $45 copay for Medicare Dental Services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and coinsurance between 0% and 20%, and other Medicare Part B drugs with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-175 (HMO) plan, but require prior authorization and a doctor's referral. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Humana Gold Plus H5619-175 (HMO) plan. Durable Medical Equipment has a 13% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 13% coinsurance, and Diabetic Supplies have a 10-20% coinsurance with no copay. Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $55, and lab services with no copay. Radiological Services are also covered, with a copay for Medicare-covered diagnostic and therapeutic radiological services, and a coinsurance for Medicare-covered X-ray services.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-175 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-175 (HMO) does not cover Cardiac Rehabilitation Services. Prior authorization and a doctor's referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-175 (HMO) plan, with a $10 copay for days 1-20, a $214 copay for days 21-55, and no copay for days 56-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services under the Humana Gold Plus H5619-175 (HMO) plan includes acupuncture with a $45 copay, and a meal benefit with no copay. However, over-the-counter items, 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 are not covered.
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