A non-government entity
Humana Gold Plus H5619-177 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-177 (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 H5619-177 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-177 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in ID. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-177 (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 H5619-177 (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 H5619-177 (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 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:
Sign up for Humana Gold Plus H5619-177 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H5619-177 (HMO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy type. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus H5619-177 (HMO) plan offers comprehensive coverage with varying cost-sharing options. Inpatient hospital stays have a copay, while outpatient services include copays and coinsurance depending on the service. Many services such as primary care, preventive care, vision, and dental services have no copay. This plan also includes coverage for ambulance services, emergency services, and hearing services, each with its own copay structure. Additional benefits include coverage for home health services, cardiac rehabilitation, skilled nursing facilities, and other services like acupuncture. Dialysis and medical equipment are covered with coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Humana Gold Plus H5619-177 (HMO) plan. For Inpatient Hospital-Acute, you will pay a $495 copay for days 1-5, and no copay for days 6-90; additional days (91-999) have no copay. For Inpatient Hospital Psychiatric, you will pay a $458 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days 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 $495, while observation services have a $495 copay. Ambulatory surgical center services and outpatient blood services have no copay, and outpatient substance abuse services have a coinsurance of 20% and a copay between $35 and $35.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-177 (HMO) plan, with a copay of $85. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Gold Plus H5619-177 (HMO) plan. Ground ambulance services have a $315 copay, while air ambulance services have a $1250 copay; there is no coinsurance for either service. 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 by the Humana Gold Plus H5619-177 (HMO) plan. Emergency Services have a $125 copay and no coinsurance, while Urgently Needed Services have a $55 copay and no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay with no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-177 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, and physician specialist services with a $35 copay. Mental health services have no copay for individual and group sessions, and physical therapy and speech-language pathology services have a $45 copay.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and kidney disease education services with no copay; other preventive services include glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. Additional services like health education, in-home safety assessment, and others are not covered.
Hearing Services See details
The Humana Gold Plus H5619-177 (HMO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $599 and $899. Prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Humana Gold Plus H5619-177 (HMO) plan covers vision services including routine eye exams with a copay of $0, and eyewear with a copay of $0, but eyeglass lenses, eyeglass frames, and upgrades are not covered. Contact lenses and eyeglasses (lenses and frames) are covered.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery. Fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
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, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-177 (HMO) plan and require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with 20% coinsurance, and Diabetic Equipment with a 10-20% coinsurance for Diabetic Supplies and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus H5619-177 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $55, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $495, 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 H5619-177 (HMO) plan with no copay and no coinsurance, but 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 the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-177 (HMO) plan, but require prior authorization. For days 1-20, there is a $10 copay; for days 21-50, the copay is $214; and for days 51-100, there is no copay.
Other Services See details
The Humana Gold Plus H5619-177 (HMO) plan covers acupuncture with a $35 copay, and up to 20 treatments per year. The plan also covers a meal benefit with no copay. Some other services such as over-the-counter items, EPSDT services, and private duty nursing services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved