Highway 19A's northern alignment begins at the junction with highways 19 and 28 in Campbell River, and goes east through the City Centre, passing by the B.C. Ferry terminal at Discovery Pier. From there, the highway hugs the coastline for 18 km before veering inland at the intersection with Oyster Garden Road. The highway continues inland for 26 km, through the communities of Saratoga Beach, Black Creek, Merville, and Tsolum before entering the city of Courtenay at the intersection with Headquarters Road. Highway 19A crosses over the Courtenay River at 17th Street, and proceeds through the southern part of the Courtenay on Cliffe Avenue before finally leaving the city at Anfield Road. From Courtenay, Highway 19A once again hugs the coastline as it proceeds southeast through the hamlets of Royston and Union Bay. Highway 19A meets a junction with highway 19 at the Buckley Bay B.C. Ferry terminal, 20 km south of Courtenay.
From Buckley Bay, highway 19A continues southeast for 37 km through the settlements of Fanny Bay and Deep Bay, as well as a junction with Bowser, finally entering the town of Qualicum Beach at an intersection with Garrett Road. The highway continues to hug the coastline in its remaining 14 km through Qualicum Beach and Parksville before finally meeting highway 19 at Craig's Crossing.
Highway 19A's Nanaimo alignment begins just off the northern end of the Nanaimo Parkway, proceeding through the north business district of the city before finally terminating at the foot of Stewart Avenue, which is part of the Trans-Canada Highway.