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Humana Gold Plus H6622-001 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-001 (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 H6622-001 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H6622-001 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Green Bay area. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H6622-001 (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 H6622-001 (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 H6622-001 (HMO), 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 $3.00. 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 $4150.00 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 H6622-001 (HMO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you will pay a $5 copay at preferred or mail-order pharmacies, and a $20 copay at standard pharmacies. For preferred brand drugs, you will pay 50% coinsurance, regardless of the pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H6622-001 (HMO) plan offers a range of benefits, including inpatient hospital stays with a $275 copay for the first six days, and no copay thereafter, as well as outpatient services with varying copays. The plan also covers services like emergency care, primary care, preventive services, and home health services, often with no copay. Additional benefits include coverage for hearing and vision services, with copays for hearing exams and prescription hearing aids, and no copay for routine eye exams and eyewear. Dental services are available, with a $40 copay for Medicare dental services, and some services covered with coinsurance. The plan also covers ambulance services, with a $315 copay for ground ambulance and 20% coinsurance for air ambulance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-6, and no copay for days 7-90, while additional days have no copay; for Inpatient Hospital Psychiatric, you pay a $275 copay for days 1-6, and no copay for days 7-90. Non-Medicare-covered stays 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 coverage for Outpatient Hospital Services with a copay of $0.00 - $300.00, Observation Services with a $275 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $35.00 and $90.00 for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial hospitalization is covered, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground Ambulance Services have a $315 copay, while Air Ambulance Services have a 20% 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, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay, while Urgently Needed Services has a $65 copay; there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H6622-001 (HMO) plan covers Primary Care Physician Services with no copay and Chiropractic Services with a $20 copay. Occupational Therapy Services have a $40 copay, while Physician Specialist Services have a $40 copay. Mental Health Specialty Services, Psychiatric Services, and Other Health Care Professional services have varying copays, and Physical Therapy and Speech-Language Pathology Services have a $40 copay. Additional Telehealth Benefits have a copay between $0 and $65, while Opioid Treatment Program Services have varying copays between $35 and $90. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Humana Gold Plus H6622-001 (HMO) plan covers preventive services with no copay for annual physical exams. Additional preventive services, including Fitness Benefit, Kidney Disease Education Services, and Other Preventive Services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, also have no copay.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams are covered with no copay for one visit per year. Fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a copay between $699 and $999 for two hearing aids per year, but hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are covered up to $100 every three months.
Vision Services See details
The Humana Gold Plus H6622-001 (HMO) plan covers vision services including routine eye exams with a copay of $0, and eyewear with a copay of $0. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $40 copay for Medicare Dental Services. Oral exams, dental x-rays, other diagnostic services, prophylaxis (cleaning), and other preventive dental services have no copay. Prosthodontics, removable and fixed, have a 30% coinsurance and no copay. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H6622-001 (HMO) plan, but require prior authorization. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment, Prosthetics, and Diabetic Equipment, is covered. Durable Medical Equipment has a 10% coinsurance, while Prosthetics/Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10-20% coinsurance with no copay, and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for all diagnostic services, with a copay ranging from $0 to $90. Diagnostic Procedures/Tests have a copay of $0, while Lab Services have no copay. Radiological Services include a copay, with Diagnostic Radiological Services having a maximum copay of $350 and Therapeutic Radiological Services having a 20% coinsurance, while Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H6622-001 (HMO) 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 not in practice. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H6622-001 (HMO) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $203; additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H6622-001 (HMO) plan covers acupuncture with a $40 copay, up to 20 treatments per year, and over-the-counter (OTC) items with a $100 maximum benefit every three months. The plan also covers a meal benefit with no copay. However, services for Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services are not covered.
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