Humana Gold Plus H5619-148 (HMO) H5619-148-0 Plan Details
Humana Gold Plus H5619-148 (HMO) H5619-148-0 Plan Details
Choosing the right Medicare Advantage plan is crucial for your healthcare needs in 2025. With Humana Gold Plus H5619-148 (HMO) as one of the options, you can compare it side-by-side with other available plans to find the best fit. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
Humana Gold Plus H5619-148 Overview
Plan ID H5619-148-0 Overview | |
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Health Plan ID: | H5619-148-0 |
Medicare Advantage Plan Type: | Local HMO |
Plan Year: | 2024 |
Monthly Premium: | $25.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $3,200 |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Humana |
Why Choose Humana Gold Plus H5619-148?
Humana Gold Plus H5619-148 is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that provides comprehensive healthcare coverage. With a monthly premium of $25.00, this plan includes the essential benefits of Medicare Part A and Part B, as well as additional services like prescription drug coverage. There is no annual deductible. Cost sharing begins with your first prescription. As an HMO plan, you’ll typically need to use providers within the plan’s network, except in emergencies.
One of the important aspects of Humana Gold Plus H5619-148 is its protection against high medical expenses. The annual maximum out-of-pocket (MOOP) limit is $3,200, ensuring that once this amount is reached, the plan covers 100% of your in-network healthcare costs for the rest of the year. This makes Humana Gold Plus H5619-148 a reliable choice for those looking for a plan that combines medical and prescription drug coverage with predictable out-of-pocket expenses.
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Out-of-Pocket Costs
Humana Gold Plus H5619-148 has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5619-148-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 Copay |
Specialist: | $0 Copay Prior Authorization Required, Referral Required |
Wellness & Preventive Programs: | None |
Preventive care: | $0 Copay |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $0 Copay Prior Authorization Required, Referral Required |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $10 Copay Prior Authorization Required, Referral Required |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $125 Copay |
Urgent care: | $10 Copay |
Ground ambulance: | $300 Copay |
Inpatient hospital care: | $200.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient hospital care: | $0 Copay Prior Authorization Required, Referral Required |
Skilled Nursing Facility: | $20.00 per day for days 1 through 20 $203.00 per day for days 21 through 34 $0.00 per day for days 35 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $15 Copay |
Outpatient group therapy: | $15 Copay |
Inpatient psychiatric hospital care: | $900.00 per stay |
Outpatient group therapy: | $15 Copay |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $15 Copay Prior Authorization Required, Referral Required |
Occupational therapy: | $15 Copay Prior Authorization Required, Referral Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 10% Coinsurance Prior Authorization Required |
Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
Prosthetics: | 20% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $200 Copay Prior Authorization Required, Referral Required |
Lab services: | $10 Copay Prior Authorization Required, Referral Required |
Outpatient x-rays: | $100 Copay Prior Authorization Required, Referral Required |
Diagnostic tests and procedures: | $100 Copay Prior Authorization Required, Referral Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by Humana Gold Plus H5619-148 as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Humana offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay Prior Authorization Required, Referral Required, Limitations Apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay Prior Authorization Required, Referral Required |
Vision | Maximum vision benefit: | $200.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay Prior Authorization Required, Referral Required |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
Humana Gold Plus H5619-148 includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
While the prescription drug plan (Part D) premium is included in the overall plan cost, some plans may have additional costs or provide assistance through the Low-Income Subsidy (LIS) program. Also known as Extra Help, LIS is a Social Security program that assists individuals with limited income and resources in reducing or eliminating Part D expenses.
The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $25.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $25.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
If you would like more information about the Extra Help program, you can refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $0.00. You must pay this amount at the pharmacy before Humana begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Humana Gold Plus H5619-148 has out-of-pocket costs that you must pay when you pick up your prescriptions.
Drug Tier | Preferred | Standard |
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1 (Preferred Generic) | N/A | $0.00 copay |
2 (Generic) | N/A | $5.00 copay |
3 (Preferred Brand) | N/A | $40.00 copay |
4 (Non-Preferred Drug) | N/A | $100.00 copay |
5 (Specialty Tier) | N/A | 33% |
How CMS Star Ratings Guide Your Choice
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Plan Availability
Humana Gold Plus H5619-148 (H5619-148-0) is available in the following locations (click to open):
Who Can Enroll in Humana Gold Plus H5619-148?
You are eligible to enroll in Humana Gold Plus H5619-148 if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
- You do not have End-Stage Renal Disease (ESRD), with some exceptions.
If these criteria describe your situation, you’re eligible to sign up for Humana Gold Plus H5619-148 and take advantage of its full range of benefits.
When Should You Enroll in Humana Gold Plus H5619-148?
To ensure you don’t miss your chance to enroll in Humana Gold Plus H5619-148, be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) to get assistance from a licensed insurance agent.
Steps to Enroll in Humana Gold Plus H5619-148
Enrolling in Humana Gold Plus H5619-148 is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Humana Gold Plus H5619-148 through the official Medicare website.
- Directly with Humana Gold Plus H5619-148: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Contact Humana
Website: | http://www.humana.com/medicare |
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Formulary: | https://www.humana.com/pharmacy/ |
Pharmacy: | Humana Pharmacy Page |
New Members: | (800)833-2364 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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