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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 2026, 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 out of 5 stars in 2026.
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 $14.00. 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 $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 $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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a 1-month supply at standard pharmacies, and featuring no copay for a 3-month supply filled via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply at standard pharmacies and through mail order. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring a 47% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. These clear copay and coinsurance structures make it easy to estimate your out-of-pocket medication costs with this Medicare plan.
Additional Benefits
The Humana Gold Plus H5619-137 (HMO) plan offers robust coverage with no copay for primary care visits, preventive services, and home health care. Specialist visits require a $30 copay, while inpatient hospital stays incur a $325 daily copay for the first five days and no copay for days six through 90. Outpatient hospital services feature copays ranging from no copay up to $620, all with no coinsurance. For supplemental care, the plan features a generous $3,500 annual limit for dental services with no copay for most preventive and comprehensive care, alongside a $200 annual eyewear allowance. Routine hearing exams have no copay, while prescription hearing aids require a copay of $299 to $599. Additionally, emergency room visits have a $130 copay, and durable medical equipment is covered with a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-137 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute days are covered at no copay, psychiatric additional days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-137 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $620 copay for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copay and no coinsurance, while outpatient substance abuse services require a $35 copay per session with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H5619-137 (HMO) 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 H5619-137 (HMO) covers Medicare-approved ground and air ambulance services with a $315 copay and no coinsurance, though prior authorization is required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H5619-137 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services require a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Humana Gold Plus H5619-137 (HMO) plan feature no copay and no coinsurance for primary care visits, and a $30 copay with no coinsurance for specialists. Therapy services require a $15 copay and no coinsurance, while mental health, psychiatric, and opioid treatments carry a $35 copay and no coinsurance. Podiatry is not covered, and chiropractic care has a $15 copay and no coinsurance, with some services covered though routine and other chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus H5619-137 (HMO) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and memory fitness, with no copay and no coinsurance. This benefit is partially covered, as sub-services such as health education, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and counseling are not covered.
Hearing Services See details
Humana Gold Plus H5619-137 (HMO) covers hearing exams with a $30 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with a $299 to $599 copay and no coinsurance for up to two aids yearly, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-137 (HMO) features partially covered vision services with no coinsurance and a $0 to $30 copay for eye exams, though routine eye exams and covered eyewear have no copay. A $200 annual maximum applies to eyewear, but other eye exams, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-137 (HMO) offers partially covered dental services up to a $3,500 annual limit, featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive and comprehensive care. Removable prosthodontics require no copay and a 30% coinsurance, while fluoride, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H5619-137 (HMO) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy and other drugs feature no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H5619-137 (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H5619-137 (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
Diagnostic and radiological services are covered by Humana Gold Plus H5619-137 (HMO) with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests have no coinsurance with a copay ranging from $0 to $90, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Humana Gold Plus H5619-137 (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-137 (HMO) covers some Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. However, in practice, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require copayments ranging from $15 to $25.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-137 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily 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 needed, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Humana Gold Plus H5619-137 (HMO) provides partial coverage for other services, which includes acupuncture for a $30 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit 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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