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Humana Gold Plus H5619-113 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-113 (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 H5619-113 (HMO-POS) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-113 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in West Virginia 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 H5619-113 (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 H5619-113 (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 H5619-113 (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 $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 $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 $8050.00 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 H5619-113 (HMO-POS) prescription drug plan has an annual drug deductible of $250. You can benefit from no copay on Tier 1 preferred generic and Tier 2 generic drugs when using a standard pharmacy or preferred mail order for both 1-month and 3-month supplies. Standard mail order for these generic tiers requires a copay of $10 to $20 for a 1-month supply. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, with 3-month supplies costing $141, or a slightly lower $131 through preferred mail order. Tier 4 non-preferred drugs require a 50% coinsurance, and Tier 5 specialty drugs require a 30% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H5619-113 (HMO-POS) plan offers robust core medical coverage with no copay or coinsurance for primary care visits, annual physical exams, and home health services. Specialist visits require a $40 copay, while inpatient hospital stays charge a $380 daily copay for the first few days and no copay for subsequent days. Outpatient care and diagnostic services feature no coinsurance, with copays ranging from no copay for lab services to $300 for certain outpatient hospital procedures. For extra wellness support, the plan provides routine dental and vision care with no copay, subject to annual limits of $3,000 and $400 respectively. Members also enjoy no copay for routine hearing exams, up to 48 free one-way transportation trips to plan-approved locations, and no copay for over-the-counter items. Emergency room visits carry a $115 copay, which is waived upon admission, while durable medical equipment and dialysis require a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus H5619-113 (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $380 daily copay for days 1 through 5 of acute stays (with no copay for days 6 through 90 and unlimited additional days) and a $380 daily copay for days 1 through 4 of psychiatric stays (with no copay for days 5 through 90). Prior authorization is required, and some services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H5619-113 (HMO-POS) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Other outpatient services require prior authorization and carry copays, ranging from $0 to $300 for outpatient hospital services, $380 per stay for observation services, and $35 per session for outpatient substance abuse services.
Partial Hospitalization See details
Humana Gold Plus H5619-113 (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 H5619-113 (HMO-POS) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered with no copay or coinsurance for up to 48 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus H5619-113 (HMO-POS) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits under the Humana Gold Plus H5619-113 (HMO-POS) include primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Physical, occupational, and mental health therapies are covered with a $35 copay and no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Humana Gold Plus H5619-113 (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, offering a memory fitness benefit with no copay, but excluding health education, weight management, and in-home safety assessments.
Hearing Services See details
Humana Gold Plus H5619-113 (HMO-POS) covers hearing services with no deductible, featuring routine exams and fitting evaluations with no copay and no coinsurance, and Medicare-covered exams for a $40 copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $999 copay and no coinsurance, though inner ear, outer ear, and over the ear models are not covered, while over-the-counter hearing aids have no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H5619-113 (HMO-POS) partially covers vision services with no coinsurance, offering routine eye exams and covered eyewear with no copay up to a $400 annual limit, while other exams may have a copay up to $40. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-113 (HMO-POS) offers partially covered dental services with a $3,000 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental services require a $40 copay and no coinsurance. Fluoride treatment, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H5619-113 (HMO-POS) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs require 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
Humana Gold Plus H5619-113 (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Humana Gold Plus H5619-113 (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 along with coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-113 (HMO-POS) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic tests ranging from no copay to a $105 copay, while radiological services include outpatient X-rays with no copay, diagnostic radiology starting with no copay, and therapeutic radiology requiring a minimum 20% coinsurance and $35 copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H5619-113 (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-113 (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization required, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-113 (HMO-POS) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though additional days beyond the 100-day Medicare limit are not covered. For covered days, there is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with prior authorization required and no prior three-day hospital stay needed.
Other Services See details
Humana Gold Plus H5619-113 (HMO-POS) offers partially covered other services, including acupuncture for a $40 copay and no coinsurance, alongside meal benefits and over-the-counter items with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while other miscellaneous services and Dual Eligible SNPs are not covered.
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