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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 2026, 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 out of 5 stars in 2026.
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.
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 $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 $4250.00 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 features an annual drug deductible of $250. For Tier 1 preferred generics and Tier 2 generics, there is no copay for one-month and three-month supplies filled at standard pharmacies or through preferred mail order. If you use standard mail order, Tier 1 drugs require a $10 copay for a one-month supply and Tier 2 drugs require a $20 copay. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply, with three-month savings available at $131 through preferred mail order. Tier 4 non-preferred drugs require a 48% coinsurance for both one-month and three-month supplies. Tier 5 specialty drugs have a 30% coinsurance for a one-month supply across all standard pharmacy and mail order channels.
Additional Benefits
The Humana Gold Plus H5619-049 (HMO-POS) plan offers comprehensive medical coverage, featuring no copay or coinsurance for primary care visits, home health services, and routine preventive care. For specialized medical needs, the plan requires a $35 copay for specialist visits and a $410 daily copay for the first seven days of an inpatient hospital stay. Outpatient services range from no copay up to a $425 copay with 20% coinsurance, while emergency room visits carry a $130 copay, which is waived if you are admitted. In addition to standard medical care, this plan includes valuable supplemental benefits like routine dental, vision, and hearing care with no copayments, subject to specific annual coverage limits. Members also benefit from no copay for up to 60 one-way transportation trips per year to approved locations, alongside covered over-the-counter items and meals. For durable medical equipment and dialysis services, members can expect a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus H5619-049 (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $410 daily copay for days 1 to 7 of acute stays (no copay for days 8 and beyond) and days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-049 (HMO-POS) covers outpatient hospital services with a copay ranging from $0 to $425 and 20% coinsurance, and observation services with a $410 copay per stay. Ambulatory surgical center and outpatient blood services feature no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H5619-049 (HMO-POS) covers partial hospitalization with a $35.00 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-049 (HMO-POS) covers ground and air ambulance services with a $335 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to non-approved health-related locations is not covered.
Emergency Services See details
Humana Gold Plus H5619-049 (HMO-POS) 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 require a $50 copay with no coinsurance, while worldwide emergency, urgent care, and emergency transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-049 (HMO-POS) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Physical, occupational, and speech therapies require a $15 to $40 copay with no coinsurance, while chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Humana Gold Plus H5619-049 (HMO-POS) covers preventive services, such as annual physical exams and kidney disease education, with no copays and no coinsurance. Additional preventive benefits are only partially covered, with services like health education, weight management programs, in-home safety assessments, and personal emergency response systems not covered under the plan.
Hearing Services See details
Humana Gold Plus H5619-049 (HMO-POS) covers hearing services, including Medicare-covered exams for a $35 copay and no coinsurance, alongside routine exams, fittings, and OTC hearing aids with no copay or coinsurance. Prescription hearing aids are partially covered with a $399 to $999 copay and no coinsurance for up to two devices per year, but inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H5619-049 (HMO-POS), offering routine eye exams and select eyewear with no copay, no coinsurance, and no deductible. Although contact lenses and eyeglasses (lenses and frames) are covered up to a $450 annual maximum, other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-049 (HMO-POS) provides partially covered dental services with a $2,500 annual limit, featuring no copay and no coinsurance for most diagnostic, preventive, and restorative care. Medicare-covered dental services require a $35 copay with no coinsurance, while fluoride treatments, implants, orthodontics, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-049 (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Associated Medicare Part B drugs, including chemotherapy and other drugs, have no copay and a 0% to 20% coinsurance, while insulin requires a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H5619-049 (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H5619-049 (HMO-POS) 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 and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus H5619-049 (HMO-POS), with prior authorization required. Lab services and diagnostic radiological services have no copay, diagnostic procedures range from a $0 to $105 copay with no coinsurance, and therapeutic radiological services require a $35 copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the Humana Gold Plus H5619-049 (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Humana Gold Plus H5619-049 (HMO-POS) with no coinsurance, although prior authorization is required. While some services are covered, standard cardiac rehabilitation (with a $15 copay), intensive cardiac rehabilitation (with a $15 copay), pulmonary rehabilitation (with a $10 to $15 copay), and supervised exercise therapy for peripheral artery disease (with a $10 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-049 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a three-day prior hospital stay is not necessary, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by Humana Gold Plus H5619-049 (HMO-POS), with Dual Eligible SNPs and other generic services not covered. Covered benefits include acupuncture for a $35 copay and no coinsurance (up to 20 treatments per year; prior authorization required), plus over-the-counter items and meal benefits with no copay and no coinsurance.
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