Humana Gold Plus H5619-186 (HMO)

Humana Gold Plus H5619-186 (HMO), plan H5619-186-000, is a 2027 Medicare Advantage plan from Humana, sold in Maine. Its in-network out-of-pocket limit for the year is $6,900.

This is an HMO plan, so it pays for your care when you use a provider in its network. Outside the network you generally pay the full cost yourself, and the exceptions are emergency care and urgently needed services, which are covered anywhere in the country. You pick a primary care provider from the network, and that doctor coordinates the rest of your care.

To join, you need Medicare Part A and Part B and you have to live in the plan's service area, which covers 5 counties in Maine for 2027. You keep paying your Part B premium to Medicare.

Counties in the service area include Kennebec, Knox, Lincoln, Penobscot and Waldo.

In network, a primary care visit is $0, a specialist visit is $75, the emergency room is $130 and urgent care is $50. Emergency care and urgently needed services are covered whether or not the provider is in the plan's network, which matters when you are away from home.

An individual mental health visit is $35 and occupational therapy is $35.

Physical therapy and speech therapy are covered too, at cost shares the plan lists in its Summary of Benefits rather than in the CMS benefit files, so check those two there.

You pay $0 for the preventive services Original Medicare covers when you use a provider in the plan's network. That includes your annual wellness visit, the recommended screenings for your age, and most vaccines. Preventive care is the easiest value to collect from any Medicare Advantage plan, so book the wellness visit early in the year.

Beyond what Original Medicare covers, this plan includes $100 toward glasses or contacts. These allowances almost always have to be used with providers and suppliers the plan works with, so check that before you buy, particularly for hearing aids where the plan usually names its own vendor.

The eyewear allowance covers eyeglasses or contact lenses, and it resets each plan year rather than rolling over, so an unused allowance is lost at the end of December.

Part D prescription drug coverage is included, so you do not need a separate drug plan. Check the plan's formulary, which is its list of covered drugs, for every medicine you take before you enroll.

For 2027, the drug deductible is $700 and your own drug costs are capped at $2,400 for the year.

The plan sorts drugs into 4 tiers, and what you pay depends on the tier and on which pharmacy you use. The tier table below shows the cost at a preferred retail pharmacy, a standard retail pharmacy, and by mail. Because drug coverage is built in, you do not add a standalone prescription drug plan on top.

If a medicine you take is not on the formulary, your prescriber can ask the plan for an exception, and if your income is limited, Extra Help can cut what you pay for drugs regardless of which plan you choose.

Some care on this plan needs prior authorization, which means Humana has to approve it before you get it. Specialist services are among those that do. Your doctor's office usually files the request, but the plan may not pay if the approval is skipped, so confirm it is in hand before a scheduled procedure. The plan's evidence of coverage lists every service that needs it.

Here is how Humana Gold Plus H5619-186 (HMO) sits against other plans sold in Kennebec County for 2027.

Humana USAA Honor Giveback (PPO) has a lower in-network limit at $4,950. AARP Medicare Advantage from UHC ME-0003 (PPO) rates higher at 4.5 stars.

This plan may fit people in the service area who are comfortable with a $6,900 ceiling on in-network costs. It suits you less well if you want to use doctors outside the network, because this type of plan generally will not pay for that.

Like any Medicare Advantage plan, it changes how your Medicare claims are paid. If you travel often, or you want to use any doctor who accepts Medicare without checking a network, compare it against Original Medicare with a Medicare Supplement and a separate drug plan before you decide.

A licensed insurance agent can check all of these against your own doctors and prescriptions at no cost.