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Humana Gold Plus H5619-049 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-049 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H5619-049 (HMO-POS) in 2025, please refer to our full plan details page.
Humana Gold Plus H5619-049 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Indiana and Kentucky. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H5619-049 (HMO-POS) 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 H5619-049 (HMO-POS).
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 H5619-049 (HMO-POS), 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. Additionally, this plan comes with a Part B Premium reduction of $2.00. You must continue to pay paying your reduced 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 $250.00 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 $4500.00 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 H5619-049 (HMO-POS) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy, or 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, you may have reduced costs for your prescriptions.
Additional Benefits
The Humana Gold Plus H5619-049 (HMO-POS) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance amounts. It also includes coverage for emergency services, primary care, and preventive services with no copays for many services, such as annual physical exams and routine hearing exams. Additionally, the plan covers hearing, vision, and dental services, along with other benefits like home health, medical equipment, and transportation, each with its own specific cost structure.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered, with a copay of $410 for days 1-7 (Acute) or 1-5 (Psychiatric) and no copay for days 8-90 (Acute) or 6-90 (Psychiatric). Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a 20% coinsurance and a copay between $0 and $425, Observation Services with a $410 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $35 and $100 for individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for many services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H5619-049 (HMO-POS) plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $315 copay for both ground and air ambulance services. Transportation services to a plan-approved health-related location are covered with no copay, with a limit of 24 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; all have no coinsurance.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services, a $20 copay for Chiropractic Services, and $15-$40 copay for Occupational Therapy Services. Physician Specialist Services have a $35 copay, and Mental Health and Psychiatric Services have a $35 copay for individual or group sessions. Physical Therapy and Speech-Language Pathology Services have a $15-$40 copay, and Additional Telehealth Benefits have a $0-$55 copay. Opioid Treatment Program Services have a $35-$100 copay.
Preventive Services See details
The Humana Gold Plus H5619-049 (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services, including wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, and fitness benefits, are covered, but may require a copay. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are also covered with no copay. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, 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 have a $35 copay. Routine hearing exams are covered with no copay, and Fitting/Evaluation for Hearing Aid is covered with no copay. Prescription Hearing Aids are partially covered, but Inner Ear, Outer Ear, and Over the Ear hearing aids are not covered, and Prescription Hearing Aids (all types) have a copay between $399 and $999. OTC Hearing Aids are covered, up to $75 every three months.
Vision Services See details
The Humana Gold Plus H5619-049 (HMO-POS) plan offers vision services, including eye exams with a copay between $0 and $35, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, with a combined maximum benefit of $200 per year, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-049 (HMO-POS) plan covers dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (fixed), and oral and maxillofacial surgery have no copay. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the Humana Gold Plus H5619-049 (HMO-POS) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus H5619-049 (HMO-POS) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $105, and lab services with no copay. Outpatient X-ray services have no copay, while therapeutic radiological services have a copay of at most $35 and coinsurance of at most 20%. Diagnostic radiological services have a copay of at most $660.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H5619-049 (HMO-POS) 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 Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for covered services, but the specific amount is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H5619-049 (HMO-POS) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H5619-049 (HMO-POS) plan covers acupuncture with a $35 copay, and also covers Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $75.00 every three months. The plan also covers a meal benefit with no copay.
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