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Humana Gold Plus H5619-183 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-183 (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 H5619-183 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-183 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Santa Barbara. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-183 (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 H5619-183 (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 H5619-183 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $60.00. 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 a $615.00 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 $6700.00 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 H5619-183 (HMO) plan features an Enhanced Alternative drug benefit with a $615.00 annual prescription drug deductible. Once this deductible is met, standard pharmacy and mail-order copays for Tier 1 preferred generics range from $10.00 to $20.00, while Tier 2 standard generics require a $47.00 copay. For higher-tier medications, you will pay a 50% coinsurance for Tier 3 preferred brands and a 25% coinsurance for Tier 4 non-preferred drugs. If you qualify for the low-income subsidy or Extra Help, your Part D premium is reduced to no cost. Additionally, once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Humana Gold Plus H5619-183 (HMO) plan offers affordable healthcare coverage with no copay for primary care visits, preventive services, and home health care. For more intensive medical needs, inpatient hospital stays require a $400 copay per day for the first six days, while outpatient hospital services range from no copay up to a $350 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care visits require a $50 copay, both with no coinsurance. Specialist visits, physical therapy, and Medicare-covered dental exams are highly accessible with a low $10 copay. Standard preventive dental care, routine hearing exams, and routine vision exams have no copay, though prescription hearing aids require a copay of $699 to $999. For specialized medical needs, durable medical equipment and dialysis services require a 20% coinsurance with no copay, while diagnostic lab services and outpatient X-rays are available with no copay.
Inpatient Hospital See details
Humana Gold Plus H5619-183 (HMO) offers partially covered inpatient hospital benefits, requiring prior authorization and doctor referrals. Acute stays require a $400 copay for days 1-6, no copay for days 7-999, and no coinsurance, while psychiatric stays carry a $900 copay with no coinsurance; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient Services are covered under the Humana Gold Plus H5619-183 (HMO) plan with no coinsurance required for any services. There is no copay for ambulatory surgical center and blood services, while outpatient hospital services range from no copay to a $350 copay, substance abuse sessions carry a $25 to $35 copay, and observation services require a $400 copay per stay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H5619-183 (HMO) with a $35 copay and no coinsurance. Prior authorization and a doctor referral are required to receive these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Humana Gold Plus H5619-183 (HMO), with covered ground ambulance services requiring a $335 copay and air ambulance services requiring a $1,250 copay, both with no coinsurance. Transportation services to plan-approved health-related locations and transportation to any health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H5619-183 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency services, urgent care, and emergency transportation are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-183 (HMO) covers primary care visits with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $10 copay. Chiropractic benefits are partially covered with a $15 copay, excluding routine chiropractic care, whereas podiatry services are not covered. Other services, including mental health, psychiatry, and telehealth, have copays ranging from $0 to $50 with no coinsurance.
Preventive Services See details
Humana Gold Plus H5619-183 (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and a memory fitness benefit, with no copays or coinsurance. However, additional preventive services are only partially covered, as the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H5619-183 (HMO) partially covers hearing services, offering routine hearing exams and fitting evaluations with no copay and Medicare-covered exams for a $10 copay, with no coinsurance or deductibles. Prescription hearing aids are covered up to two per year with a copay ranging from $699 to $999 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-183 (HMO) partially covers vision services, offering eye exams with a $0 to $10 copay and covered eyewear with no copay, up to a $150 annual limit, with no coinsurance or deductibles. While routine eye exams, contact lenses, and eyeglasses (lenses and frames) are covered, separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-183 (HMO) with no copay or coinsurance for preventive care like oral exams and cleanings, and a $10 copay with no coinsurance for Medicare-covered dental services. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered, though select restorative and surgical services are available as optional supplemental benefits.
Home Infusion bundled Services See details
Humana Gold Plus H5619-183 (HMO) covers home infusion bundled services, requiring prior authorization and step therapy for certain drugs. Medicare Part B chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H5619-183 (HMO) covers Dialysis Services with a 20% coinsurance and no copay. Prior authorization and a doctor referral are required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H5619-183 (HMO) covers medical equipment, including durable medical equipment (DME) with a 20% coinsurance and no copay. Prosthetic devices and medical supplies require a 20% coinsurance, while diabetic supplies have a 10% coinsurance with no copay, and diabetic therapeutic shoes or inserts carry a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Humana Gold Plus H5619-183 (HMO) with a required doctor referral and prior authorization. Members will pay no copay or coinsurance for lab services and outpatient X-rays, a $0 to $50 copay with no coinsurance for diagnostic procedures, a $0 to $300 copay with no coinsurance for diagnostic radiology, and a 20% coinsurance with no copay for therapeutic radiological services.
Home Health Services See details
Home health services are covered by Humana Gold Plus H5619-183 (HMO) with no copay and no coinsurance. Members must obtain prior authorization and a doctor referral to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Humana Gold Plus H5619-183 (HMO) plan, as all individual sub-services, including intensive cardiac, pulmonary, and SET for PAD, are excluded from coverage. Since these services are not covered under the plan, there is no copay or coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by Humana Gold Plus H5619-183 (HMO), requiring prior authorization and a doctor referral, though additional days beyond the Medicare-covered limit are not covered. For covered stays, patients pay a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance.
Other Services See details
Humana Gold Plus H5619-183 (HMO) offers partially covered Other Services, as Over-the-Counter (OTC) items and Dual Eligible SNPs with Highly Integrated Services are not covered. Covered acupuncture services require a $10 copay and no coinsurance for up to 20 treatments yearly, while the meal benefit is offered with no copay and no coinsurance.
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