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Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2026 to people living in 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 SNP-DE H5619-182 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H5619-182 (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.
For Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $21.70. 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 $9250.00 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 SNP-DE H5619-182 (HMO D-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members enjoy no copay for both 1-month and 3-month supplies at standard pharmacies and through preferred mail order. If you choose standard mail order, Tier 1 drugs require a $10 copay for a 1-month supply and $30 for a 3-month supply, while Tier 2 drugs require a $20 copay for a 1-month supply and $60 for a 3-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan charges a flat 25% coinsurance. This 25% coinsurance applies to standard pharmacies, preferred mail order, and standard mail order options. While Tier 3 and Tier 4 medications are available in both 1-month and 3-month supplies at this rate, Tier 5 specialty drugs are limited to a 1-month supply.
Additional Benefits
The Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) plan offers comprehensive medical coverage with no copay and 20% coinsurance for primary care, specialist visits, and mental health services. For hospital services, there is a $2,230 copay per stay for acute inpatient care and a $250 copay with 20% coinsurance for outpatient hospital visits. Emergency room visits require a $115 copay, while urgently needed services have a $40 copay, with no coinsurance for either. Additional benefits include dental, vision, and hearing services, featuring no copay and no coinsurance for routine dental care up to $1,750 annually and eyeglasses up to a $400 yearly limit. Members also receive home health services, over-the-counter items, and up to 24 one-way transportation trips per year to plan-approved locations with no copay and no coinsurance. Routine hearing aid coverage is also provided, allowing up to two prescription aids every three years with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and non-Medicare-covered stays, acute hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers outpatient hospital services with a $250 copay and 20% coinsurance, and ambulatory surgical center services with a $200 copay and 20% coinsurance. Outpatient substance abuse and blood services are also covered with no copay and 20% coinsurance, with prior authorization required for most services.
Partial Hospitalization See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) 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 are covered with 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
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers primary care, specialist visits, mental health, and therapy services with no copay and a 20% coinsurance. Telehealth services are covered with a $0 to $40 copay and 20% coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for memory fitness, in-home support, smoking cessation, and chemotherapy-related wigs, while services like health education, weight management, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services covered by the Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) plan include routine hearing exams with a 20% coinsurance and no copay, and unlimited fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two aids every three years, though inner ear, outer ear, and over the ear models are not covered, while unlimited OTC hearing aids are covered with no copay or coinsurance.
Vision Services See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) offers partially covered vision services with no deductible, featuring one annual routine eye exam and contact lenses with no copay and 20% coinsurance. Eyeglasses (lenses and frames) are covered with no copay and no coinsurance up to a $400 annual limit, while other eye exams, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP), offering no copay and no coinsurance for most diagnostic, preventive, and comprehensive care up to a $1,750 annual limit, while Medicare-covered dental services require a 20% 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 under the Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) plan, requiring prior authorization and featuring coinsurance ranging from no coinsurance up to 20% for Part B chemotherapy, radiation, and other drugs. Covered Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance with no deductible, while other Part B drugs require no copay.
Dialysis Services See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers durable medical equipment, prosthetic devices, medical supplies, and diabetic supplies with a 20% coinsurance and no copay. Diabetic therapeutic shoes and inserts are also covered with no copay, and prior authorization is required for these medical equipment benefits.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers diagnostic and radiological services with a 20% coinsurance, requiring prior authorization for all services. Under this coverage, lab services have no copay, diagnostic tests range from no copay to a $40 copay, outpatient X-rays require a $40 copay, and diagnostic radiological services have a minimum copay of $200.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) plan with no copay and require prior authorization; however, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Humana Gold Plus SNP-DE H5619-182 (HMO D-SNP) covers acupuncture with no copay and 20% coinsurance for up to 20 treatments per year, alongside over-the-counter items and chronic illness meals with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while highly integrated dual eligible services and other optional services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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