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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 2025, 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 3.5 out of 5 stars in 2025.
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 $200.00 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:
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Drug Coverage
The Humana Gold Plus H5619-111 (HMO-POS) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you will pay $8.00 for a preferred generic drug at a preferred pharmacy, and 50% coinsurance for a preferred brand drug. Once your total drug costs reach $2000.00, you will enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Humana Gold Plus H5619-111 (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $245, and emergency services with copays. The plan also covers primary care visits with no copay, along with various specialist services with set copays. Additional benefits include coverage for hearing exams, vision services, and dental services, all with varying copays. The plan also provides coverage for home health services with no copay, and skilled nursing facility stays with copays for a limited number of days.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered under the Humana Gold Plus H5619-111 (HMO-POS) plan. For days 1-5, there is a $260 copay, and for days 6-90, there is no copay; additional days for acute care have no copay.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $245, observation services with a $260 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay between $0 and $35 for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H5619-111 (HMO-POS) plan, with a $35 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Humana Gold Plus H5619-111 (HMO-POS) plan. Ground and Air Ambulance Services have a $315 copay, and there is no coinsurance. 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 $140 copay, and Urgently Needed Services have a $65 copay, but all have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $140 copay.
Primary Care See details
The Humana Gold Plus H5619-111 (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physician specialist services with a $30 copay. Mental health specialty services and psychiatric services have no copay for individual and group sessions, while physical therapy and speech-language pathology services have a $25 copay; additional telehealth benefits have a copay between $0 and $65, and opioid treatment program services have a copay between $0 and $35. Routine Chiropractic Care is not covered, and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services with no copay, an annual physical exam with no copay, and other preventive services with no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. Additional preventive services, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers kidney disease education services and a fitness benefit with no copay.
Hearing Services See details
Hearing exams are covered with a $30 copay, and routine hearing exams have no copay. Prescription hearing aids are covered, with a copay between $399 and $699, and OTC hearing aids are covered up to $50 every three months.
Vision Services See details
Vision services include eye exams with a copay between $0 and $30, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered, while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H5619-111 (HMO-POS) plan offers 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, all with no copay. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H5619-111 (HMO-POS) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and requires prior authorization, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Equipment includes Diabetic Supplies with a 10-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $90, lab services have no copay, diagnostic radiological services have a maximum copay of $325, therapeutic radiological services have a copay between $30 and $35, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered 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 not in practice. 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Humana Gold Plus H5619-111 (HMO-POS) plan, with a copay of $20 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services," Humana Gold Plus H5619-111 (HMO-POS) covers acupuncture with a $30 copay, and over-the-counter items, and meal benefits with no copay. Several other services are not covered, including Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more.
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