Humana Gold Plus SNP-DE H5619-136 (D-SNP) Costs & Coverage, Benton County, Washington
Humana Gold Plus SNP-DE H5619-136 (D-SNP) Costs & Coverage, Benton County, Washington
Explore the benefits and costs of Humana Gold Plus SNP-DE H5619-136 (D-SNP HMO), a 2025 Medicare Special Needs Plan designed to meet your unique healthcare needs. Dive into this detail page to see how this Humana SNP can support your specific health conditions or financial circumstances.
Available in Benton County, WA, to qualified residents, Humana Gold Plus SNP-DE H5619-136 offers all of the same basic benefits as Original Medicare, but out-of-pocket costs are different. It may include additional benefits that Medicare Part A and Part B do not cover.
Plan ID H5619-136-4 Overview | |
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Health Plan ID: | H5619-136-4 |
Medicare Advantage Plan Type: | HMO |
Plan Year: | 2024 |
Monthly Premium: | $35.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | |
Part B Give Back: | $0.00/mo |
Part D Drug Plan Benefit: | Basic $545.00 deductible |
Supplemental Benefits: | Vision, Hearing |
Availability: | Benton County, WA |
Insured By: | Humana |
We're Here to Help You Enroll |
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Health Plan Cost Sharing & Benefits
Humana Gold Plus SNP-DE H5619-136 is a Health Maintenance Organization (HMO) plan. As an HMO D-SNP member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Humana Gold Plus SNP-DE H5619-136 does cover out-of-network care for emergencies and out-of-area dialysis.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | 0% Coinsurance |
Specialist: | 0% Coinsurance Prior Authorization Required, Referral Required |
Wellness & Preventive Programs: | |
Preventive care: | 0% Coinsurance |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | 0% Coinsurance Prior Authorization Required, Referral Required |
Routine Foot Care: | 0% Coinsurance Prior Authorization Required, Referral Required |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | 0% Coinsurance Prior Authorization Required, Referral Required |
Routine chiropractic: | 0% Coinsurance Prior Authorization Required, Referral Required |
Emergency and Urgent Care | |
Emergency room care: | 0% Coinsurance |
Urgent care: | 0% Coinsurance |
Ground ambulance: | 0% Coinsurance |
Inpatient hospital care: | $2,080.00 per stay |
Outpatient hospital care: | 0% Coinsurance Prior Authorization Required, Referral Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $203.00 per day for days 21 through 65 $0.00 per day for days 66 and beyond |
Optional supplemental benefits: | Not Covered |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | 0% Coinsurance |
Outpatient group therapy: | 0% Coinsurance |
Inpatient psychiatric hospital care: | $1,937.00 per stay |
Outpatient group therapy: | 0% Coinsurance |
Outpatient individual therapy: | 0% Coinsurance Prior Authorization Required |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | 0% Coinsurance Prior Authorization Required, Referral Required |
Occupational therapy: | 0% Coinsurance Prior Authorization Required, Referral Required |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | 0% Coinsurance Prior Authorization Required |
Durable medical equipment: | 0% Coinsurance Prior Authorization Required |
Prosthetics: | 0% Coinsurance |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | 0% Coinsurance Prior Authorization Required, Referral Required |
Lab services: | 0% Coinsurance Prior Authorization Required, Referral Required |
Outpatient x-rays: | 0% Coinsurance Prior Authorization Required, Referral Required |
Diagnostic tests and procedures: | 0% Coinsurance Prior Authorization Required, Referral Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 0% Coinsurance |
Other Part B drugs (Medicare-covered) | 0% Coinsurance |
Supplemental Health Plan Benefits (H5619-136-4)
The following is a summary of the supplemental benefits Humana includes 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 | |
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: | $350.00 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 Supplemental Benefits
None specified.
Prescription Drug Plan Costs & Benefits
Humana Gold Plus SNP-DE H5619-136 includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid Services, whereas enhanced benefit plans cover more.
Prescription Drug Plan Premium
Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
Basic Part D Premium: | $35.00 |
Supplemental Part D Premium: | $0.00 |
Total Part D Premium: | $35.00 |
Part D Premium with Full LIS Assistance: | $0.00 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $545.00. This is the amount you must pay 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 SNP-DE H5619-136 has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
Drug Tier | Preferred | Standard |
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$0 copay on all covered generic and brand-name prescriptions. |
CMS Rating Marks
The Centers for Medicare & Medicaid Services (CMS) annually rates Medicare Advantage D-SNPs in nine key categories using a 5-star system. These ratings help you gauge the quality of care and service you might receive with this Humana plan.
CMS Measure | Star Rating |
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2025 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 |
How to Qualify for Enrollment in Humana Gold Plus SNP-DE H5619-136
To enroll in Humana Gold Plus SNP-DE H5619-136 you must qualify for both Medicare and Medicaid and live in one of the plan's service areas. Eligibility for Medicare requires you to be either 65 years of age or older, or have received Social Security Disability Insurance for at least 24 months. For Medicaid eligibility, your income and assets must fall at or below your state's thresholds.
Before enrolling in Humana Gold Plus SNP-DE H5619-136, or any other dual-eligible SNP, make sure to ask yourself the following questions:
- What out-of-pocket costs should I anticipate (premiums, deductibles, copayments)?
- Will I be able to continue seeing my doctors? Are they within the plan's network?
- Are the plan's in-network providers and facilities conveniently located?
- Does the plan cover services from providers who are out-of-network?
- Will I need a referral to visit a specialist?
- Are my medications included in the Part D plan's formulary? What options are available if I can't afford my medications?
- What special accommodations does the plan provide for individuals with disabilities?
- Does the plan include free meal delivery after a hospital stay?
- What support is available for caregivers? Is adult day care covered?
- Does the plan provide a prepaid card for over-the-counter medications and covered groceries?
Important Enrollment Periods
After confirming your eligibility for Humana Gold Plus SNP-DE H5619-136, it’s essential to understand when you can enroll or make changes to your Medicare plan. The following enrollment periods are key:
- Initial Enrollment Period (IEP): This is your first opportunity to enroll when you become Medicare-eligible.
- Annual Enrollment Period (AEP): The annual window when you can review and adjust your Medicare coverage.
- Special Enrollment Periods (SEPs): Special situations may allow you to enroll or change plans outside of the standard periods.
To get a deeper understanding of these enrollment periods, click here to learn more and stay informed about your Medicare choices.
Contact Humana
Call 1-877-388-0596 (TTY 711) to speak with a licensed HealthCompare insurance agent (Mon-Sun 8am-11pm EST) and learn more about this Special Needs Plan and other plans on this site.
You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
Plan Website: | http://www.humana.com/medicare |
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Formulay Information: | https://www.humana.com/pharmacy/ |
Pharmacy Information: | Humana Pharmacy Page |
Prospective Members: | (800)833-2364 |
TTY Users: | 711 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered through Medicare.org
Medicare Advantage and Part D plans and benefits offered are 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.