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UC San Diego Health Humana (HMO)

H5619 - 131 - 0
3.5 out of 5 stars (3.5 / 5)

humana medicare provider logo

UC San Diego Health Humana (HMO) is a Medicare Advantage Plan by Humana.

This page features plan details for 2025 UC San Diego Health Humana (HMO) H5619 – 131 – 0 available in San Diego County.

Locations

UC San Diego Health Humana (HMO) is offered in the following locations.

California
San Diego County, California

Click to see more locations

Plan Overview

UC San Diego Health Humana (HMO) offers the following coverage and cost-sharing.

Insurer:Humana
Health Plan Deductible:$0
MOOP:$950 In-network
Drugs Covered:Yes

Ready to sign up for UC San Diego Health Humana (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

UC San Diego Health Humana (HMO) qualifies for a monthly Medicare Give Back Benefit of $6.00.

Premium Reduction:$6.00

Premium Breakdown

UC San Diego Health Humana (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $6.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

UC San Diego Health Humana (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

UC San Diego Health Humana (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required, Referral Required)
  • Endodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required, Referral Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – 0.00 Copay (Authorization Required, Referral Required)
  • Periodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required, Referral Required)
  • Prosthodontics, fixed
    • In-Network: 30 Coins – 0.00 Copay (Authorization Required, Referral Required)
  • Prosthodontics, removable
    • In-Network: 30 Coins – 0.00 Copay (Authorization Required, Referral Required)
  • Restorative Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required, Referral Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – 0.00 Copay
  • Other Preventive Dental Services
    • In-Network: No Coins – 0.00 Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • $0 copay (Authorization Required, Referral Required)
  • Lab services
    • $0 copay (Authorization Required, Referral Required)
  • Diagnostic radiology services (e.g., MRI)
    • $0-50 copay (Authorization Required, Referral Required)
  • Outpatient x-rays
    • $0 copay (Authorization Required, Referral Required)

Doctor visits

  • Specialist
    • $0 copay (Authorization Required, Referral Required)
  • Primary
    • $0 copay

Emergency care/Urgent care

  • Urgent care
    • $0 copay
  • Emergency
    • $80 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • Not covered
  • Foot exams and treatment
    • $0 copay (Authorization Required, Referral Required)

Ground ambulance

    • $195 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • $0 copay (Authorization Required, Referral Required)
  • Medicare-Covered Hearing Exam
    • $0 copay (Authorization Required, Referral Required)
  • Hearing aids OTC
    • Not covered
  • Hearing aids
    • $199-499 copay (Limits Apply)

Inpatient hospital coverage

    • $100 per stay (Authorization Required, Referral Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $950 In-network

Medical equipment/supplies

  • Diabetes supplies
    • $0 copay or 10% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • 9% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • 0-20% coinsurance (Authorization Required)

Mental health services

  • Inpatient hospital – psychiatric
    • $100 per stay (Authorization Required, Referral Required)
  • Outpatient individual therapy visit
    • $25 copay (Authorization Required, Referral Required)
  • Outpatient individual therapy visit with a psychiatrist
    • $25 copay (Authorization Required, Referral Required)
  • Outpatient group therapy visit with a psychiatrist
    • $25 copay (Authorization Required, Referral Required)
  • Outpatient group therapy visit
    • $25 copay (Authorization Required, Referral Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $0-50 copay per visit (Authorization Required, Referral Required)

Preventive care

    • $0 copay

Rehabilitation services

  • Physical therapy and speech and language therapy visit
    • $0 copay (Authorization Required, Referral Required)
  • Occupational therapy visit
    • $0 copay (Authorization Required, Referral Required)

Skilled Nursing Facility

    • $0 per day for days 1 through 20
      $100 per day for days 21 through 100 (Authorization Required, Referral Required)

Transportation

    • Not covered

Vision

  • Eyeglass frames
    • Not covered
  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Eyeglass lenses
    • Not covered
  • Other
    • Not covered
  • Routine eye exam
    • $0 copay (Limits Apply, Authorization Required, Referral Required)
  • Upgrades
    • Not covered
  • Contact lenses
    • $0 copay (Limits Apply, Authorization Required, Referral Required)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for UC San Diego Health Humana (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

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