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Humana Gold Plus Giveback H5619-066 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H5619-066 (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 Giveback H5619-066 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H5619-066 (HMO) is a HMO 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 Giveback H5619-066 (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 Giveback H5619-066 (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 Giveback H5619-066 (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 $78.00. 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 $355.00 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 $8250.00 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 Giveback H5619-066 (HMO) plan features a $355 annual drug deductible. For Tier 1 preferred generic drugs, you will pay no copay at standard pharmacies or through preferred mail order for both one-month and three-month supplies. Tier 2 generic drugs are also highly affordable, costing just a $1 copay for a one-month supply at standard pharmacies or preferred mail order, with no copay for a three-month supply via preferred mail order. Tier 3 preferred brand drugs require a $46 copay for a one-month supply at standard pharmacies and preferred mail order. If you need Tier 4 non-preferred drugs, you will pay a 45% coinsurance across standard pharmacies and mail order options. Specialty medications in Tier 5 carry a 29% coinsurance for a one-month supply regardless of whether you use standard pharmacies or mail order services.
Additional Benefits
The Humana Gold Plus Giveback H5619-066 (HMO) plan offers comprehensive coverage for essential medical needs, featuring no copay and no coinsurance for primary care visits, annual physical exams, and Medicare preventive services. Specialist visits require a $40 copay, while inpatient hospital stays carry an $875 copay per stay with no coinsurance. Outpatient care is highly accessible, with no coinsurance and no copay for ambulatory surgical center services, lab tests, and outpatient X-rays. Members also benefit from dental, vision, and hearing coverage, which includes routine eye and hearing exams with no copay, alongside up to $250 annually for covered eyewear. Emergency room visits require a $115 copay, which is waived if admitted, and urgent care visits have a $40 copay. Additionally, home health services are fully covered with no copay and no coinsurance, helping you easily manage your health.
Inpatient Hospital See details
Humana Gold Plus Giveback H5619-066 (HMO) partially covers inpatient hospital services, which require a $875 copayment per stay and no coinsurance for Medicare-covered acute and psychiatric stays. Prior authorization is required, and certain services such as hospital upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H5619-066 (HMO) outpatient services are covered with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from no copay to $725, observation services carry a $450 copay per stay, and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Humana Gold Plus Giveback H5619-066 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H5619-066 (HMO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, with prior authorization required. Routine transportation services to health-related locations are not covered.
Emergency Services See details
Humana Gold Plus Giveback H5619-066 (HMO) covers emergency services with a $115 copay and no coinsurance, which is 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, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Humana Gold Plus Giveback H5619-066 (HMO) offer no copay and no coinsurance for primary care physician visits, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, speech, and mental health therapies are covered with a $35 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus Giveback H5619-066 (HMO) covers Medicare preventive services, annual physical exams, kidney disease education, and screenings with no copay and no coinsurance. Additional preventive services are only partially covered, featuring a memory fitness benefit with no copay and no coinsurance, but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, bathroom safety, and counseling.
Hearing Services See details
Humana Gold Plus Giveback H5619-066 (HMO) covers hearing services, including Medicare-covered exams for a $40 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two aids per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are partially covered under the Humana Gold Plus Giveback H5619-066 (HMO) plan, which offers one routine eye exam per year with no copay and no coinsurance, while other eye exams are not covered. Covered eyewear has no copay or coinsurance up to a $250 yearly limit for contact lenses or eyeglasses (lenses and frames), but separate eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Giveback H5619-066 (HMO) partially covers dental services, offering Medicare-covered dental care with a $40 copay and no coinsurance, and preventive services with no copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus Giveback H5619-066 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require a coinsurance ranging from no coinsurance to 20%, with insulin also having a $35 copay.
Dialysis Services See details
Humana Gold Plus Giveback H5619-066 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus Giveback H5619-066 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with 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 Giveback H5619-066 (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $100 copay for diagnostic procedures. Covered radiological services require prior authorization and include outpatient X-rays with no copay, diagnostic radiology with a $0 minimum copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Gold Plus Giveback H5619-066 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under Humana Gold Plus Giveback H5619-066 (HMO) with no coinsurance, but in practice only some services are covered. Specifically, standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($15 copay), and SET for PAD services ($20 copay) are not covered and require prior authorization.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus Giveback H5619-066 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and a prior three-day inpatient hospital stay is not required, though additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus Giveback H5619-066 (HMO), including acupuncture with a $40 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for these covered benefits, while over-the-counter (OTC) items are not covered.
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