Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP)

Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Maine. This plan received an overall rating of 3 out of 5 stars in 2026.

It's important to know that Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP) 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 SNP-DE H5619-003 (HMO D-SNP).

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.

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:

Drug Coverage

The Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP) plan features an annual drug deductible of $310. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using standard pharmacies or preferred mail order services for both 1-month and 3-month supplies. If you choose standard mail order for these tiers, copays range from $10 to $20 for a 1-month supply and $30 to $60 for a 3-month supply. For higher-tier medications, the plan transitions to coinsurance rather than set copayments. Tier 3 preferred brands and Tier 4 non-preferred drugs require a 25% coinsurance across standard pharmacies, preferred mail order, and standard mail order options. Specialty drugs in Tier 5 carry a 29% coinsurance for a 1-month supply through all available pharmacy and mail order channels.

Additional Benefits

The Humana Gold Plus SNP-DE H5619-003 (HMO D-SNP) plan offers comprehensive coverage with varying cost-sharing structures depending on the service. For inpatient hospital stays, members pay a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay with no coinsurance, while primary care visits, specialist consultations, and diagnostic services generally feature no copay and a 20% coinsurance. Outpatient hospital services require a copay ranging from no copay to $250 plus 20% coinsurance, though ambulatory surgical center visits and home health services are fully covered with no copay and no coinsurance. Everyday healthcare needs like routine dental, vision, and hearing services are partially covered, featuring no copay and up to 20% coinsurance alongside generous annual allowances of $400 for eyewear and $1,500 for select dental treatments. Emergency care is accessible with a $115 copay, which is waived upon hospital admission, and urgent care carries a $40 copay. Additionally, the plan includes up to 24 one-way trips per year to approved locations and routine hearing aids at no copay and no coinsurance.