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Humana Gold Plus H5619-001 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-001 (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 H5619-001 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-001 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Southern Maine. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-001 (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 H5619-001 (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 H5619-001 (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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $590.00 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 $9350.00 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 H5619-001 (HMO) plan has an enhanced alternative drug benefit. You will pay a $590 deductible before your drug coverage begins. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For preferred generic drugs, you will pay a $5 copay at preferred mail-order pharmacies and a $20 copay at standard mail-order pharmacies. Standard generic drugs have a $47 copay. Preferred brand drugs have 43% coinsurance, and non-preferred drugs have 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H5619-001 (HMO) plan offers a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay, and outpatient services have copays depending on the service. Other services, such as primary care, preventive services, and dental services, often have no copay. The plan includes coverage for hearing and vision, with copays for exams and no copays for eyewear. The plan also covers ambulance services, emergency services, and home health services with a copay or coinsurance. Additionally, the plan covers some over-the-counter items, and offers a meal benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you'll pay a $390 copay for days 1-5 and no copay for days 6-90, while for Inpatient Hospital Psychiatric, the copay is $350 for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services for the Humana Gold Plus H5619-001 (HMO) plan include coverage for Outpatient Hospital Services with a copay of $50-$575, Observation Services with a copay of $390, Ambulatory Surgical Center (ASC) Services with a copay of $340, and Outpatient Substance Abuse Services with copays ranging from $45-$95 for both individual and group sessions. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-001 (HMO) plan. This benefit has a $55 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H5619-001 (HMO) plan, with a $315 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H5619-001 (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has a $45 copay, and all have no coinsurance.
Primary Care See details
The Humana Gold Plus H5619-001 (HMO) plan covers primary care physician services with no copay. Chiropractic services have a $10 copay, while occupational therapy services have a $35 copay. Physician specialist services have a $45 copay, and physical therapy and speech-language pathology services have a $35 copay. Mental health and psychiatric services have a $40 copay for individual and group sessions. Additional telehealth benefits have a copay between $0 and $45, and opioid treatment program services have a copay between $45 and $95. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include no copay for annual physical exams, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Additional preventive services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The Humana Gold Plus H5619-001 (HMO) plan covers hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) have a copay between $699 and $999, while OTC hearing aids are covered with a maximum benefit of $45 every three months. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Humana Gold Plus H5619-001 (HMO) plan covers vision services, including eye exams with a copay ranging from $0 to $45, and eyewear with no copay. Eyeglasses lenses and frames are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-001 (HMO) plan covers dental services, including oral exams with no copay, dental x-rays with no copay, other diagnostic dental services with no copay, prophylaxis (cleaning) with no copay, other preventative dental services with no copay, and adjunctive general services with no copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H5619-001 (HMO) plan. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-001 (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. Durable Medical Equipment has a 12% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 12% coinsurance, and Diabetic Supplies have a 10% coinsurance with no copay, while Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $100, and lab services with no copay. Radiological services include diagnostic and therapeutic services with a copay up to $390 for the former, and coinsurance of at least 20% for the latter, as well as outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-001 (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not specify the cost sharing details, and the following services are not covered: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-001 (HMO) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H5619-001 (HMO) plan covers acupuncture with a $45 copay, and covers over-the-counter items with a maximum plan benefit coverage amount of $45 every three months. The plan also covers a meal benefit with no copay. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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