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Humana Gold Plus H5619-180 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-180 (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 H5619-180 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-180 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in New Hampshire. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-180 (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 H5619-180 (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 H5619-180 (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.
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 $6700.00 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 H5619-180 (HMO) plan features a $400 drug deductible. Tier 1 preferred generic drugs have no copay at standard pharmacies and through preferred mail order for both one-month and three-month supplies. Tier 2 generic drugs cost a $5 copay for a one-month supply at standard pharmacies, with no copay required for a three-month supply filled via preferred mail order. For Tier 3 preferred brand drugs, members pay a $47 copay for a one-month supply, which drops to $131 for a three-month supply through preferred mail order. Tier 4 non-preferred drugs carry a 47% coinsurance, while Tier 5 specialty drugs require a 28% coinsurance for a one-month supply. This plan offers clear pricing tiers to help you estimate your annual Medicare prescription drug expenses.
Additional Benefits
The Humana Gold Plus H5619-180 (HMO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care visits, routine preventive services, and home health care. Specialists, outpatient mental health, and partial hospitalization services are available with a $35 copay and no coinsurance. Inpatient hospital stays require a $325 daily copay for the first five days, after which there is no copay, while emergency care carries a $130 copay that is waived upon hospital admission. Additional benefits include routine dental, vision, and hearing services, which feature no copay for routine exams alongside a $250 annual eyewear allowance and a $2,000 yearly dental limit. For medical equipment, prosthetics, and dialysis services, members will pay a 20% coinsurance with no copay. This plan also supports overall wellness by providing up to 24 one-way trips to plan-approved locations, over-the-counter items, and chronic illness meal benefits with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-180 (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. Unlimited additional acute hospital days are covered at no copay, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-180 (HMO) covers outpatient services with no coinsurance, though prior authorization is required for most treatments. Outpatient hospital copays range from $0 to $700 (with a $325 copay per stay for observation services), outpatient substance abuse sessions carry a $35 copay, and ambulatory surgical center and blood services have no copays.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H5619-180 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by Humana Gold Plus H5619-180 (HMO), featuring a $335 copay and no coinsurance for both ground and air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transport to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H5619-180 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-180 (HMO) offers primary care visits with no copay and no coinsurance, while specialist, mental health, and psychiatric services have a $35 copay and no coinsurance. Physical, occupational, and speech therapy services require a $15 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under Humana Gold Plus H5619-180 (HMO) are partially covered, providing covered options like annual physicals, kidney disease education, memory fitness, and select screenings with no copay and no coinsurance. Uncovered services under this benefit include health education, weight management, nutritional therapy, in-home safety assessments, personal emergency response systems, and telemonitoring.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H5619-180 (HMO) with no coinsurance, featuring a $35 copay for Medicare-covered exams and no copay for annual routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $99 to $699, though inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
Humana Gold Plus H5619-180 (HMO) provides partially covered vision services with no deductibles or coinsurance, including one routine eye exam and one pair of select eyewear (contacts or eyeglasses) per year with no copay. A $250 annual maximum applies to eyewear, while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services under the Humana Gold Plus H5619-180 (HMO) plan are partially covered, offering up to a $2,000 annual maximum with a $35 copay and no coinsurance for Medicare-covered dental. Most other covered preventive and comprehensive services have no copay and no coinsurance, though fixed prosthodontics requires a 30% coinsurance and no copay. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H5619-180 (HMO) with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H5619-180 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Humana Gold Plus H5619-180 (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 or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-180 (HMO) covers diagnostic and radiological services, requiring prior authorization for most procedures. Lab services have no copay and no coinsurance, diagnostic tests have copays ranging from $0 to $90 with no coinsurance, and radiological services vary from a $0 minimum copay for diagnostic imaging to a minimum 20% coinsurance plus copays for therapeutic radiology. Outpatient X-rays feature no copay, though coinsurance may apply.
Home Health Services See details
Humana Gold Plus H5619-180 (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-180 (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-180 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but not requiring a prior three-day inpatient hospital stay. You will pay a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-180 (HMO) offers partial coverage for other services, featuring acupuncture for a $35 copay and no coinsurance (limited to 20 treatments per year), plus over-the-counter items and meal benefits for chronic illnesses with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, and certain other miscellaneous services and dual eligible SNP benefits are not covered.
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