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Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) is a HMO-POS D-SNP 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 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP).
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 SNP-DE H5619-123 (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $14.70. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $590.00 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 $9350.00 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 SNP-DE H5619-123 (HMO-POS D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. The plan's premium may be reduced if you qualify for the low-income subsidy, with a monthly premium of $14.70.
Additional Benefits
The Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a $1910 copay per admission, while outpatient services, including substance abuse and blood services, have coinsurance requirements. Emergency and urgent care services are covered with copays and coinsurance, and ambulance services have 20% coinsurance. This plan includes coverage for primary care, preventive, hearing, vision, and dental services with various cost-sharing options. Many services, such as home health and skilled nursing facilities, have no copay, while others, like diagnostic and radiological services, have coinsurance requirements. The plan also offers additional benefits like acupuncture and over-the-counter items with specific coverage limits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a copay of $1910 per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include outpatient hospital services with 20% coinsurance, observation services with 20% coinsurance, ambulatory surgical center (ASC) services with a coinsurance between 20% and 20%, outpatient substance abuse services with a coinsurance between 20% and 20% for both individual and group sessions, and outpatient blood services with no copay. Prior authorization is required for many services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) plan, but requires prior authorization. You will pay 19% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, up to 48 one-way trips per year, and transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay with no coinsurance, while Urgently Needed Services have a 20% coinsurance with no copay. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Occupational Therapy Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Opioid Treatment Program Services have a minimum and maximum coinsurance of 20%.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay. Other preventive services, including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay. However, services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and others are not covered.
Hearing Services See details
Hearing exams and fitting/evaluation for hearing aids are covered with a coinsurance of at most 20% for routine hearing exams and no copay. Prescription hearing aids have a maximum plan benefit of $500 per year, per ear, with no copay, while OTC hearing aids have a $0 copay and a maximum benefit of $500 per ear, every year.
Vision Services See details
The Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance. The plan also covers contact lenses and eyeglasses (lenses and frames) with no copay, but does not cover eyeglass lenses, eyeglass frames, or upgrades.
Dental Services See details
Dental Services are covered, with a $2,500 annual maximum. Medicare Dental Services have a 20% coinsurance, and other services include oral exams, dental x-rays, other diagnostic services, cleaning, other preventive services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics, fixed, and oral and maxillofacial surgery with no copay, while fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implants and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), is covered with a 19% coinsurance and no copay. Prosthetics/Medical Supplies are covered with no copay, and coinsurance applies to Medicare-covered devices and supplies. Diabetic Equipment is covered, with coinsurance and copayments for some services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests and Lab Services have a coinsurance of at most 20%, while Lab Services have no copay. Diagnostic Radiological Services and Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $50 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) plan 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 none of the specific sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus SNP-DE H5619-123 (HMO-POS D-SNP) plan covers acupuncture with a 20% coinsurance, and a meal benefit with no copay. Over-the-counter items are covered, with a maximum benefit coverage amount of $1500.00 per year. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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