A non-government entity
Humana Gold Plus H5619-111 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-111 (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 H5619-111 (HMO-POS) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-111 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in Arkansas and Oklahoma. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H5619-111 (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 H5619-111 (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 H5619-111 (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 $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 $3700.00 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:
Sign up for Humana Gold Plus H5619-111 (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H5619-111 (HMO-POS) plan features an Enhanced Alternative drug benefit with an annual prescription drug deductible of $615.00. After meeting this deductible, you will pay a $5.00 copay for Tier 1 preferred generics at standard pharmacies and preferred mail, or a $47.00 copay for Tier 2 standard generics. For higher tiers, the plan charges a 50% coinsurance for Tier 3 preferred brands and a 25% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will have no copay for Medicare Part D covered drugs. Additionally, qualifying members who receive Extra Help or the low-income subsidy will pay nothing for their Part D premium. This plan provides clear cost-sharing phases to help you manage your healthcare budget.
Additional Benefits
The Humana Gold Plus H5619-111 (HMO-POS) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, home health services, and routine preventive care. For inpatient hospital stays, members pay a $260 daily copay for days one through five, followed by no copay for days six through 90. Outpatient hospital services feature no coinsurance, with copays ranging from no copay up to $245, while emergency room visits require a $150 copay that is waived if admitted. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,000 annual limit and vision services up to a $250 yearly limit with no copay or coinsurance for most routine services. Routine hearing exams and over-the-counter hearing aids are also available with no copay, though prescription hearing aids require copays between $199 and $499. For medical equipment and dialysis, members can expect no copay and a coinsurance ranging from 10% to 20%.
Inpatient Hospital See details
Humana Gold Plus H5619-111 (HMO-POS) partially covers inpatient hospital benefits, which require a $260 daily copay for days 1 through 5 and no copay or coinsurance for days 6 through 90 for acute and psychiatric admissions. While additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-111 (HMO-POS) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Copayments for other covered services range from $30 to $35 for outpatient substance abuse sessions, $0 to $245 for outpatient hospital services, and $260 per stay for observation services.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the Humana Gold Plus H5619-111 (HMO-POS) plan with a $35 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-111 (HMO-POS) partially covers Ambulance and Transportation Services, offering ground and air ambulance services for a $335 copay and no coinsurance. Transportation services to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H5619-111 (HMO-POS) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-111 (HMO-POS) covers primary care physician services with no copay and no coinsurance. Other covered services, such as specialist, therapy, and mental health visits, have copays ranging from $0 to $35 and no coinsurance, while podiatry and routine chiropractic care are not covered.
Preventive Services See details
Humana Gold Plus H5619-111 (HMO-POS) covers essential preventive services, including annual physical exams, kidney disease education, and memory fitness benefits, with no copay or coinsurance. However, this benefit is only partially covered, as several supplemental services like health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus H5619-111 (HMO-POS) covers hearing services with no coinsurance, including routine hearing exams and OTC hearing aids for no copay, and Medicare-covered exams for a $20 copay. Prescription hearing aids are partially covered with a $199 to $499 copay and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Humana Gold Plus H5619-111 (HMO-POS), featuring no copay for annual routine eye exams, a $0 to $20 copay for other eye exams, and no coinsurance. Covered eyewear such as contact lenses and eyeglasses has no copay and no coinsurance up to a $250 yearly limit, though separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-111 (HMO-POS) partially covers dental services up to a $2,000 annual limit, offering most preventive and comprehensive services with no copay and no coinsurance. Medicare-covered dental services require a $20 copay and no coinsurance, while fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Humana Gold Plus H5619-111 (HMO-POS) plan, requiring prior authorization and step therapy. For covered Part B drugs, insulin requires a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H5619-111 (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus H5619-111 (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies require 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 H5619-111 (HMO-POS) covers diagnostic and radiological services with prior authorization, offering no copay and no coinsurance for lab and outpatient X-ray services. Diagnostic tests range from no copay to a $90 copay with no coinsurance, diagnostic radiology costs up to a $360 copay with no coinsurance, and therapeutic radiology requires a $20 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus H5619-111 (HMO-POS) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are provided by Humana Gold Plus H5619-111 (HMO-POS) under prior authorization; while some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. There is no coinsurance for this benefit, and copays may apply to covered services.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-111 (HMO-POS) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and featuring a $20 copay for days 1-20 and a $218 copay for days 21-100 with no coinsurance. Additional days beyond those covered by Medicare are not covered.
Other Services See details
Humana Gold Plus H5619-111 (HMO-POS) partially covers other services, excluding Dual Eligible SNPs with highly integrated services. Covered benefits include acupuncture for a $20 copay and no coinsurance, as well as meal benefits and over-the-counter items with no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved