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Humana Gold Plus H5619-069 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-069 (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 H5619-069 (HMO-POS) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-069 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Arkansas. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-069 (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 H5619-069 (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 H5619-069 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 $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 $6750.00 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 H5619-069 (HMO-POS) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. Once this deductible is met, your copay for Tier 1 preferred generic drugs is $10.00 at standard pharmacies and preferred mail order, while Tier 2 standard generics carry a $47.00 copay. For brand-name and specialty medications, you will pay a 50% coinsurance for Tier 3 preferred brands and a 25% coinsurance for Tier 4 non-preferred drugs. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for covered Medicare Part D prescription drugs. This plan also offers reduced prescription costs for individuals who qualify for the low-income subsidy Extra Help program. Please review the plan's formulary to confirm how your specific prescriptions are covered.
Additional Benefits
The Humana Gold Plus H5619-069 (HMO-POS) plan offers comprehensive coverage for essential medical needs, featuring no copay for primary care doctor visits and preventive services like annual exams. For specialized care, members pay a $25 copay for specialists, while inpatient hospital stays require a $295 daily copay for the first six days followed by no copay for days 7 to 90. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgent care services require a $50 copay. This plan also provides supplemental benefits, including routine eye exams and eyewear up to a $250 annual limit, and routine hearing exams with no copay. Dental care is covered up to a $750 annual limit with no copay for select services, while medical equipment and dialysis generally require a 20% coinsurance with no copay. Additionally, home health services, laboratory tests, and outpatient X-rays are fully covered with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-069 (HMO-POS) offers partially covered inpatient hospital benefits with a $295 daily copay for days 1 to 6 and no copay or coinsurance for days 7 to 90. While acute care includes unlimited additional days with no copay, this plan does not cover hospital upgrades, non-Medicare-covered stays, or additional days for psychiatric care.
Outpatient Services See details
Humana Gold Plus H5619-069 (HMO-POS) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Patients will pay a copay of up to $320 for outpatient hospital services, $295 per stay for observation services, and $30 to $35 per session for outpatient substance abuse services.
Partial Hospitalization See details
Partial hospitalization benefits are covered by Humana Gold Plus H5619-069 (HMO-POS) with a $35 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by Humana Gold Plus H5619-069 (HMO-POS), which does not cover transportation services to plan-approved or any health-related locations. Covered ground ambulance services require a $335 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for all ambulance services.
Emergency Services See details
Humana Gold Plus H5619-069 (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 H5619-069 (HMO-POS) primary care benefits are partially covered, as podiatry services are not covered. Covered services require no coinsurance, featuring no copay for primary care physician visits, a $25 copay for specialists, and copays ranging from $15 to $50 for chiropractic, therapy, and telehealth services.
Preventive Services See details
Preventive services are covered by Humana Gold Plus H5619-069 (HMO-POS) with no copay and no coinsurance for annual exams, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, EKGs, and memory fitness. However, these benefits are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, extra smoking cessation, disease management, telemonitoring, remote access, bathroom safety devices, and counseling.
Hearing Services See details
Humana Gold Plus H5619-069 (HMO-POS) partially covers hearing services, as OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. Covered hearing exams require a $25 copay, with no copay for routine exams or fitting evaluations, and covered prescription hearing aids carry a $199 to $499 copay, with no deductibles or coinsurance for any of these services.
Vision Services See details
Vision Services are partially covered under the Humana Gold Plus H5619-069 (HMO-POS) plan, featuring no coinsurance and no copay for routine eye exams and eyewear, which has a $250 annual limit. Other eye exams may require a copay of up to $25, while standalone eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Gold Plus H5619-069 (HMO-POS) up to a $750 annual limit, excluding fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics. Medicare dental services require a $25 copay and no coinsurance, while other covered services feature no copay and range from no coinsurance to 30% or 40% coinsurance.
Home Infusion bundled Services See details
Humana Gold Plus H5619-069 (HMO-POS) covers Home Infusion bundled services, requiring prior authorization and step therapy. Covered Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, while other Part B drugs, including chemotherapy and radiation drugs, have no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Humana Gold Plus H5619-069 (HMO-POS) and require prior authorization. Members will pay a 20% coinsurance and no copay for these covered services.
Medical Equipment See details
Humana Gold Plus H5619-069 (HMO-POS) covers medical equipment, including durable medical equipment (DME), 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.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-069 (HMO-POS) covers diagnostic and radiological services, with prior authorization required. Lab services and outpatient X-rays have no copay and no coinsurance, while diagnostic tests require a $0 to $100 copay and diagnostic radiology requires a $0 to $360 copay, both with no coinsurance. Therapeutic radiological services carry a $25 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus H5619-069 (HMO-POS) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to access these covered services.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-069 (HMO-POS) does not cover Cardiac Rehabilitation Services in practice. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, meaning there is no copay or coinsurance provided for these treatments.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered under Humana Gold Plus H5619-069 (HMO-POS), as additional days beyond the Medicare-covered limit are not covered. Covered stays require prior authorization and carry a daily copay of $10 for days 1 to 20 and $218 for days 21 to 100, with no coinsurance.
Other Services See details
Other Services are partially covered by Humana Gold Plus H5619-069 (HMO-POS), offering acupuncture and meal benefits with no copay and no coinsurance, both of which require prior authorization. Over-the-counter items and highly integrated dual eligible SNP services are not covered.
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