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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 2026, 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 out of 5 stars in 2026.
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.
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 $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) Medicare plan offers an Enhanced Alternative prescription drug benefit with no annual drug deductible. During the initial coverage phase, you will enjoy no copay for Tier 1 preferred generic drugs at standard pharmacies and preferred mail-order services. For other tiers, standard generic drugs require a $47 copay, while preferred brand and non-preferred drugs carry a 50% and 33% coinsurance, respectively. After your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy, also known as Extra Help, will benefit from a reduced $0 cost-share.
Additional Benefits
The Humana Gold Plus H5619-178 (HMO) offers robust healthcare coverage with many essential services featuring no copays and no coinsurance. Beneficiaries benefit from no copays for acute inpatient hospital stays, primary and specialist doctor visits, preventive care, and home health services. For urgent or emergency needs, the plan requires a $150 copay for emergency room visits and a $65 copay for urgent care, both with no coinsurance. Routine dental, vision, and hearing care are also highly accessible, offering no copays or coinsurance alongside generous allowances like a $3,000 annual dental limit. Some specialized treatments and equipment require cost-sharing, such as a 15% coinsurance for durable medical equipment, a 20% coinsurance for dialysis, and a $335 copay for ground ambulance services.
Inpatient Hospital See details
Humana Gold Plus H5619-178 (HMO) offers partially covered inpatient hospital benefits, requiring prior authorization and doctor referrals. Acute inpatient stays feature no copay and no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Psychiatric inpatient stays require a $375 copay per admission and no coinsurance, while additional days and non-Medicare-covered stays are excluded.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H5619-178 (HMO) with no coinsurance, featuring no copay for ambulatory surgical center, blood, and observation services. Outpatient hospital services require a copay of $0 to $35, while outpatient substance abuse sessions carry a copay ranging from $25 to $35.
Partial Hospitalization See details
Humana Gold Plus H5619-178 (HMO) covers partial hospitalization benefits with a $35 copay and no coinsurance. These services require both prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-178 (HMO) offers partially covered ambulance and transportation services, as transportation to plan-approved and any health-related locations is not covered. Covered ground ambulance services require a $335 copay and air ambulance services require a $1,250 copay, with no coinsurance for either service.
Emergency Services See details
Humana Gold Plus H5619-178 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-178 (HMO) covers primary care, specialist, and therapy services with no copay and no coinsurance, while mental health, psychiatric, telehealth, and opioid treatment services require copays ranging from $0 to $65 and no coinsurance. Chiropractic care is partially covered, with routine chiropractic care excluded, and podiatry services are not covered by this plan.
Preventive Services See details
Preventive services are covered by Humana Gold Plus H5619-178 (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, memory fitness, and select screenings. However, these benefits are only partially covered, as supplemental services like health education, weight management, and nutritional counseling are not covered.
Hearing Services See details
Humana Gold Plus H5619-178 (HMO) offers partially covered hearing services, featuring no copay or coinsurance for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids (all types) require a $699 to $999 copay with no coinsurance, while inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-178 (HMO) covers routine eye exams and eyewear with no copay and no coinsurance, providing a $300 annual maximum benefit for contact lenses and complete eyeglasses. Vision services are only partially covered under this plan, as individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-178 (HMO) dental services are partially covered up to an annual maximum of $3,000. Most covered services, including exams, cleanings, and x-rays, feature no copay and no coinsurance, though fixed and removable prosthodontics require a 30% coinsurance and no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-178 (HMO) covers home infusion bundled services, requiring prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while other covered Part B chemotherapy, radiation, and miscellaneous drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H5619-178 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H5619-178 (HMO) covers durable medical equipment (DME) with a 15% coinsurance and no copay, and prosthetics or medical supplies with a 15% to 20% coinsurance and no copay. Diabetic supplies are covered with a 10% coinsurance and no copay, whereas diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Humana Gold Plus H5619-178 (HMO) with prior authorization and doctor referrals required. There is no copay or coinsurance for lab services, outpatient X-rays, and diagnostic radiological services, while diagnostic tests carry a $0 to $65 copay and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H5619-178 (HMO) with no copay and no coinsurance, though a doctor referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-178 (HMO) states some services are covered, but in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered, meaning there is no copay or coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by Humana Gold Plus H5619-178 (HMO), requiring prior authorization and a doctor referral. There is no copay or coinsurance for days 1 through 20 and a $218 daily copay with no coinsurance for days 21 through 100, though additional days beyond Medicare-covered stays are not covered.
Other Services See details
Humana Gold Plus H5619-178 (HMO) partially covers Other Services, as meal benefits and Dual Eligible SNPs are not covered. Covered benefits like acupuncture and over-the-counter items are offered with no copay and no coinsurance.
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