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Humana Gold Plus H5619-178 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-178 (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 H5619-178 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-178 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Riverside and San Bernardino Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-178 (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 H5619-178 (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 H5619-178 (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $375.00 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 H5619-178 (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy type. For example, you will have no copay for preferred generic drugs at a standard pharmacy and preferred mail order, but a $20 copay at a standard mail order. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-178 (HMO) plan offers comprehensive coverage, including no copay for inpatient hospital stays (acute), outpatient services, many primary and preventive care services, hearing exams, vision services, and dental services. You'll also have access to home health services with no copay. The plan includes copays for emergency services ($75), ground ambulance ($145), and inpatient psychiatric stays ($375), as well as coinsurance for services like dialysis, medical supplies, and therapeutic radiological services. There is a $3,000 maximum benefit per year for other dental services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered by the Humana Gold Plus H5619-178 (HMO) plan. For Inpatient Hospital-Acute, there is no copay for a Medicare-covered stay, and additional days are unlimited with no copay; however, Non-Medicare-covered Stay and Upgrades are not covered. For Inpatient Hospital Psychiatric, the copay is $375 per admission or stay, and additional days and non-Medicare stays are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services have no copay, and Individual and Group Sessions for Outpatient Substance Abuse have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-178 (HMO) plan, requiring prior authorization and a doctor referral. The plan has a $10 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-178 (HMO) plan. Ground ambulance services have a $145 copay, while air ambulance services have a $1250 copay, and both have no coinsurance; however, 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 under the Humana Gold Plus H5619-178 (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation have a $75 copay, while Urgently Needed Services have no copay. There is no coinsurance for these services.
Primary Care See details
The Humana Gold Plus H5619-178 (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, physician specialist services, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Chiropractic services, individual and group sessions for mental health specialty services, other health care professional services, individual and group sessions for psychiatric services, and opioid treatment program services have a $0 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Humana Gold Plus H5619-178 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additionally, the plan covers services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, all with no copay. However, some services like Health Education, In-Home Safety Assessments, and others are not covered.
Hearing Services See details
Hearing services include hearing exams with no copay, routine hearing exams with no copay for one visit per year, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, and OTC hearing aids are covered up to $75 every three months. Prescription hearing aids (all types) have a copay between $699 and $999 for two visits per year, and prescription hearing aids (inner ear, outer ear, and over the ear) are not covered.
Vision Services See details
Humana Gold Plus H5619-178 (HMO) covers vision services including routine eye exams and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered, but there is a combined maximum of $150 per year for eyewear.
Dental Services See details
Humana Gold Plus H5619-178 (HMO) 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, and 30% coinsurance for prosthodontics (removable and fixed), while fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan also has a $3,000 maximum benefit per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-178 (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus H5619-178 (HMO) plan. Durable Medical Equipment (DME) has no coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have no copay, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Lab services have no copay, and therapeutic radiological services have a 20% coinsurance, and other services may have a copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-178 (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 specific services like Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus H5619-178 (HMO) plan. There is no copay for days 1-20, and a $50 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H5619-178 (HMO) plan covers acupuncture with no copay, but requires prior authorization and is limited to 20 treatments per year. This plan also provides over-the-counter (OTC) items as a supplemental benefit, with a maximum coverage amount of $75 every three months, and the amount carries over if unused. Other services like meal benefits, and others are not covered.
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