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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 2026, 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 out of 5 stars in 2026.
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 $1.00. 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 $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 $6800.00 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) prescription drug plan has an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost a $5 copay for a one-month supply, with no copay required for a three-month supply when filled via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a one-month supply, or a reduced $131 copay for a three-month supply through preferred mail order. Tier 4 non-preferred drugs require a 33% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply.
Additional Benefits
The Humana Gold Plus H5619-001 (HMO) Medicare plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health care, and key preventive services. For specialized medical needs, members pay a $40 copay for specialist visits, a $115 copay for emergency services, and daily copays for inpatient hospital stays with no coinsurance. Outpatient hospital services and surgeries are also highly accessible, featuring no coinsurance and copays ranging from no copay up to $575. This plan also includes valuable supplemental benefits, featuring no copay or coinsurance for routine vision exams, preventive dental cleanings up to a $1,250 annual limit, and routine hearing exams. Prescription hearing aids require copays between $399 and $699, while durable medical equipment and dialysis services generally require a 20% coinsurance with no copay. Additionally, members can benefit from covered over-the-counter items and chronic illness meals with no copay and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-001 (HMO) covers inpatient hospital services with no coinsurance, requiring a $390 daily copay for days 1 to 5 of an acute stay (no copay thereafter) and a $350 daily copay for days 1 to 5 of a psychiatric stay (no copay for days 6 to 90). This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by Humana Gold Plus H5619-001 (HMO) feature no coinsurance, with no copays for ambulatory surgical center and outpatient blood services. Medicare-covered outpatient hospital services carry a copay of $0 to $575 (including a $390 copay per stay for observation services), while individual and group outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H5619-001 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-001 (HMO) covers ground and air ambulance services with a $315 copay and no coinsurance, subject to prior authorization. Although transportation services are listed as covered, transportation to plan-approved or health-related locations is not covered in practice.
Emergency Services See details
Humana Gold Plus H5619-001 (HMO) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent care, and emergency transportation are all covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-001 (HMO) covers primary care physician visits with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, speech, and mental health therapies require a $35 copay and no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Humana Gold Plus H5619-001 (HMO) covers key preventive services, including annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management, and memory fitness, with no copay and no coinsurance. However, the benefit is only partially covered, as services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge 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, home safety modifications, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H5619-001 (HMO) hearing services are partially covered, featuring Medicare-covered exams for a $40 copay and no coinsurance, alongside routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are covered up to two per year with copays between $399 and $699 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-001 (HMO) provides partially covered vision services with no deductible and no coinsurance. Covered benefits include one routine eye exam and one pair of contact lenses or eyeglasses per year (up to a $250 maximum) with no copay, while other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-001 (HMO), featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other preventive and comprehensive services up to a $1,250 annual maximum. While many services like exams, cleanings, and extractions are covered, fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-001 (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B chemotherapy and other drugs require between no coinsurance and 20% coinsurance, while Part B insulin is covered with a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H5619-001 (HMO) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is covered by Humana Gold Plus H5619-001 (HMO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies feature a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-001 (HMO) covers diagnostic and radiological services with prior authorization required, offering no copay for lab services and outpatient X-rays. Diagnostic procedures and tests carry a copay ranging from $0 to $100 with no coinsurance, while therapeutic radiological services require a minimum 20% coinsurance and diagnostic radiological services have a copay starting at $0.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H5619-001 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Humana Gold Plus H5619-001 (HMO) with no copay and no coinsurance, though some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H5619-001 (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services covered by Humana Gold Plus H5619-001 (HMO) include acupuncture with a $40 copay and no coinsurance, as well as over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is limited to 20 treatments per year, and both acupuncture and meal benefits require prior authorization.
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