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Humana Gold Plus H5619-053 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-053 (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 H5619-053 (HMO-POS) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-053 (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 H5619-053 (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 H5619-053 (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 H5619-053 (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 $3.00. 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 $4850.00 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 H5619-053 (HMO-POS) plan features an annual drug deductible of $250. For Tier 1 preferred generic drugs, there is no copay for 1-month or 3-month supplies at standard retail pharmacies or through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a 1-month supply and no copay for a 3-month supply via preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $47 copay for a 1-month supply. Tier 4 non-preferred drugs carry a 50% coinsurance for both 1-month and 3-month supplies, while Tier 5 specialty drugs require a 30% coinsurance. Utilizing preferred mail order services can help minimize your overall out-of-pocket costs under this plan.
Additional Benefits
The Humana Gold Plus H5619-053 (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits and physical therapy, members will pay a $45 copay with no coinsurance, while urgent care requires a $50 copay. Inpatient hospital stays require a $530 daily copay for the first few days with no coinsurance, while emergency room visits carry a $130 copay. This plan also features strong supplemental benefits, including dental coverage up to a $2,500 annual limit and vision care with up to $400 yearly for eyewear, both featuring no copay for routine services. Routine hearing exams are also available with no copay, though prescription hearing aids require copays ranging from $699 to $999. Additionally, members can access up to 24 one-way transportation trips per year and diagnostic lab services with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by Humana Gold Plus H5619-053 (HMO-POS) with no coinsurance, requiring a $530 daily copay for days 1 to 5 of acute stays and days 1 to 4 of psychiatric stays, with no copays for subsequent days. Prior authorization is required, and certain services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H5619-053 (HMO-POS) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital and observation services require copays ranging from $0 to $580, while outpatient substance abuse sessions have a $35 copay, with prior authorization required for most benefits.
Partial Hospitalization See details
Humana Gold Plus H5619-053 (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-053 (HMO-POS) covers ground and air ambulance services with a $335 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
Humana Gold Plus H5619-053 (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 and 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 H5619-053 (HMO-POS) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $45 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services carry a $35 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H5619-053 (HMO-POS) with no copay and no coinsurance for covered options, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management. While a memory fitness benefit is included, other supplemental services—including health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy—are not covered.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus H5619-053 (HMO-POS), offering Medicare-covered exams for a $45 copay and no coinsurance, alongside routine exams and fitting evaluations for no copay and no coinsurance. Prescription hearing aids are partially covered with a $699 to $999 copay and no coinsurance for up to two devices per year, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H5619-053 (HMO-POS), offering routine eye exams and eyewear with no coinsurance and copays ranging from $0 to $45. Covered benefits include one routine exam and up to $400 yearly for contact lenses or eyeglasses with no copay, though other eye exams, separate lenses or frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-053 (HMO-POS), featuring a $45 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most other preventive and comprehensive services up to a $2,500 annual limit. While cleanings, exams, X-rays, and extractions are covered, fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H5619-053 (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H5619-053 (HMO-POS) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Humana Gold Plus H5619-053 (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 or inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-053 (HMO-POS) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a copay between $0 and $105. Radiological services require prior authorization and feature no copay for outpatient X-rays, a $0 minimum copay for diagnostic radiological services, and a minimum $45 copay and 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered by the Humana Gold Plus H5619-053 (HMO-POS) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered by Humana Gold Plus H5619-053 (HMO-POS) with no coinsurance and required prior authorization, but in practice only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-053 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copayment for days 1 through 20 and a $218 daily copayment for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Humana Gold Plus H5619-053 (HMO-POS) partially covers other services, offering acupuncture with a $45.00 copay and no coinsurance for up to 20 treatments per year, alongside meal benefits for chronic illnesses with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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