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Humana Gold Plus H5619-137 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-137 (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 H5619-137 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-137 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in New Hampshire and Select Counties in 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 H5619-137 (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 H5619-137 (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 H5619-137 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.80. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $400.00 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 $6400.00 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 H5619-137 (HMO) plan has a $400 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you may pay a $5 copay for a preferred generic drug at a standard or preferred pharmacy, or a 50% coinsurance for a preferred brand drug. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H5619-137 (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and primary care visits have copays ranging from $0-$580. Emergency services and ambulance services have copays, and home health services have no copay. This plan also covers hearing and vision services, with copays for exams and no copays for routine exams. Dental services have no copay for many services. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services with copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered; however, non-Medicare-covered stays and upgrades for inpatient hospital-acute, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered. For inpatient hospital-acute and psychiatric services, you will pay a $325 copay for days 1-5, and no copay for days 6-90. For additional days for inpatient hospital-acute, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $35 to $580, and observation services with a $325 copay. Ambulatory Surgical Center (ASC) Services have a $310 copay, and outpatient substance abuse services have copays between $35 and $100 for individual and group sessions. Outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-137 (HMO) plan. This benefit requires prior authorization and has a $55 copay.
Ambulance and Transportation Services See details
Ambulance services are covered by the Humana Gold Plus H5619-137 (HMO) plan, with a $315 copay for both ground and air ambulance services and no coinsurance. Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H5619-137 (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Transportation have a $125 copay, while Urgently Needed Services have a $55 copay.
Primary Care See details
Primary Care Physician Services have no copay, while Chiropractic Services have a $15 copay, and require prior authorization. Occupational Therapy Services have a $35 copay. Physician Specialist Services have a $35 copay and require prior authorization. Mental Health Specialty Services, Individual and Group sessions, have a $35 copay and require prior authorization. Physical Therapy and Speech-Language Pathology Services have a $35 copay and require authorization. Additional Telehealth Benefits have a copay between $0 and $55. Opioid Treatment Program Services have a copay between $35 and $100 and require prior authorization. Podiatry Services are not covered.
Preventive Services See details
Preventive services include no copay for an annual physical exam and other Medicare-covered services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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
Hearing exams are covered with a $35 copay, and routine hearing exams are covered with no copay for one exam per year, and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are partially covered, with a copay between $699 and $999 for all types of prescription hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a copay between $0 and $35, while routine eye exams have no copay. Eyewear, contact lenses, and eyeglasses (lenses and frames) have no copay, with a combined maximum benefit of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-137 (HMO) covers dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Medicare Dental Services have a $35 copay. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance can range from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance can range from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-137 (HMO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered by this plan. DME has a 19% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies also have a 19% coinsurance, while Diabetic Supplies have a 10% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and lab services with a copay, and outpatient x-ray services with no copay, while diagnostic radiological services have a copay between $40 and $325, and therapeutic radiological services have a 20% coinsurance. Diagnostic procedures/tests have a copay between $0 and $90.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-137 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-137 (HMO) plan, with a copay of $10 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H5619-137 (HMO) plan covers acupuncture with a $35 copay and covers a meal benefit with no copay. The plan does not cover over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services.
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