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Humana Gold Plus H5619-122 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H5619-122 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H5619-122 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H5619-122 (HMO) is a HMO 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 H5619-122 (HMO) 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 H5619-122 (HMO).
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 H5619-122 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.00. 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 $5900.00 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 H5619-122 (HMO) Medicare plan offers an enhanced alternative prescription drug benefit with an annual drug deductible of $615.00. During the initial coverage phase, you will pay a $10.00 copay for Tier 1 preferred generic drugs at standard pharmacies or preferred mail order, while Tier 2 standard generics require a $47.00 copay. For higher tiers, you will pay a 47% coinsurance for Tier 3 preferred brand drugs 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 pay nothing for covered Part D prescriptions. Additionally, individuals who qualify for the low-income subsidy, also known as Extra Help, can reduce their drug premium cost from $13.00 down to $4.10.
Additional Benefits
The Humana Gold Plus H5619-122 (HMO) plan offers affordable access to essential medical care, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Inpatient hospital stays require a $290 daily copay for days one through five, followed by no copay for days six through 90 with no coinsurance. Emergency care is available with a $130 copay, while urgent care visits require a $50 copay and no coinsurance. Routine dental, vision, and hearing exams are covered with no copay or coinsurance, alongside annual allowances for eyewear and preventive dental care. Diagnostic lab services and outpatient X-rays also feature no copay, while high-tier services like durable medical equipment and dialysis require a 20% coinsurance with no copay. Specialized treatments, such as acupuncture and Medicare-covered dental, are accessible with low copays and no coinsurance.
Inpatient Hospital See details
Humana Gold Plus H5619-122 (HMO) covers inpatient acute and psychiatric hospital stays with a $290 daily copay for days 1 through 5, no copay for days 6 through 90, and no coinsurance. Unlimited additional acute days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H5619-122 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Copays for other covered services range from $0 to $295 for outpatient hospital visits, $290 per stay for observation services, and $30 to $35 per session for outpatient substance abuse treatment.
Partial Hospitalization See details
Humana Gold Plus H5619-122 (HMO) covers partial hospitalization benefits with a $35 copay and no coinsurance. Prior authorization is required for this covered service.
Ambulance and Transportation Services See details
Humana Gold Plus H5619-122 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are not covered.
Emergency Services See details
Humana Gold Plus H5619-122 (HMO) 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 are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available for a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H5619-122 (HMO) partially covers primary care benefits, featuring no copay or coinsurance for primary care physician visits. Other covered services, such as specialist, therapy, and telehealth visits, require copays ranging from $0 to $50 and no coinsurance, while podiatry and routine chiropractic care are not covered.
Preventive Services See details
Humana Gold Plus H5619-122 (HMO) covers preventive services, such as annual physical exams, kidney disease education, and diabetes self-management training, with no copays or coinsurance. However, additional preventive benefits are only partially covered, as services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus H5619-122 (HMO), offering routine hearing exams and fitting evaluations with no copay or coinsurance, and Medicare-covered exams for a $20 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a $399 to $699 copay and no coinsurance, while over-the-counter hearing aids and inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H5619-122 (HMO) provides partially covered vision services, featuring no copay and no coinsurance for annual routine eye exams and select eyewear up to a $250 yearly limit. Other eye exams require a copay of up to $20, while standalone eyeglass lenses, standalone eyeglass frames, and eyewear upgrades are not covered.
Dental Services See details
Humana Gold Plus H5619-122 (HMO) offers partially covered dental services, featuring a $20 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for covered preventive and comprehensive services up to a $1,500 annual limit. Fluoride, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H5619-122 (HMO) with prior authorization. Covered Medicare Part B chemotherapy and other Part B drugs require no copay and a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus H5619-122 (HMO) plan with a 20% coinsurance and no copay. Prior authorization is required to receive these benefits.
Medical Equipment See details
Humana Gold Plus H5619-122 (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with prior authorization required. DME, prosthetics, and medical supplies require a 20% coinsurance and no copay, while diabetic supplies carry a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H5619-122 (HMO) covers diagnostic and radiological services with prior authorization, offering no copay or coinsurance for lab services and outpatient X-rays. Diagnostic tests and radiological services have copays ranging up to $90 and $360, respectively, with no coinsurance, while therapeutic radiology requires a $20 copay and 20% coinsurance.
Home Health Services See details
Humana Gold Plus H5619-122 (HMO) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Humana Gold Plus H5619-122 (HMO) indicates some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Since these services are not covered in practice, there are no copays or coinsurance costs for members.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H5619-122 (HMO) partially covers Skilled Nursing Facility (SNF) services with prior authorization, requiring a $10 daily copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coinsurance. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H5619-122 (HMO) partially covers other services, including acupuncture for a $20 copay and no coinsurance, and a meal benefit with no copay and no coinsurance. Over-the-counter items and dual eligible SNPs with highly integrated services are not covered under this benefit.
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