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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 2026, 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 2026.
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.
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 $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 $4200.00 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 features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs require a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, with no copay required for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply across standard pharmacies and mail-order services. Higher-tier medications are subject to coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty tier drugs requiring a 25% coinsurance. These clear cost-sharing tiers help beneficiaries estimate their annual out-of-pocket expenses for prescription medications.
Additional Benefits
The Humana Gold Plus H6622-001 (HMO) plan offers comprehensive medical coverage with no copay for primary care physician visits, annual physical exams, and home health services. For inpatient hospital stays, members pay a $275 daily copay for days 1 through 6, with no copay for days 7 through 90. Specialist visits require a $35 copay, and emergency room care is available with a $150 copay that is waived upon hospital admission. Additional benefits include dental coverage up to a $2,500 annual maximum with no copay for most preventive and comprehensive services. Vision benefits provide a routine eye exam and up to $400 annually for eyewear with no copay, while over-the-counter hearing aids and routine hearing exams also feature no copay. Furthermore, members can receive acupuncture treatments for a $35 copay and access diagnostic lab services with no copay.
Inpatient Hospital See details
Humana Gold Plus H6622-001 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $275 copay per day for days 1 to 6 and no copay for days 7 through 90. Unlimited additional acute days are covered at no copay, but the plan does not cover psychiatric additional days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Humana Gold Plus H6622-001 (HMO) covers outpatient services with no coinsurance, though copays and prior authorization requirements vary by service. Ambulatory surgical center and outpatient blood services have no copay, while outpatient hospital services range from a $0 to $300 copay, observation services carry a $275 copay per stay, and outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus H6622-001 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H6622-001 (HMO) covers ambulance services with a $335 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H6622-001 (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H6622-001 (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $35 copay and no coinsurance. Covered therapy, mental health, and psychiatric services have copays ranging from $25 to $30 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H6622-001 (HMO) covers preventive services, such as annual physical exams, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, EKGs, and a fitness benefit, with no copay and no coinsurance. However, additional preventive services are only partially covered, and the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, or counseling.
Hearing Services See details
Humana Gold Plus H6622-001 (HMO) covers Medicare-covered hearing exams for a $35 copay and no coinsurance, alongside routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered—with inner ear, outer ear, and over-the-ear models not covered—for a copay of $699 to $999 and no coinsurance, while over-the-counter (OTC) hearing aids are covered with no copay and no coinsurance.
Vision Services See details
Humana Gold Plus H6622-001 (HMO) partially covers vision services with no deductibles, offering one routine eye exam per year and up to $400 annually for eyewear (one pair of contact lenses or eyeglasses with lenses and frames) with no copay and no coinsurance. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H6622-001 (HMO) partially covers dental services up to a $2,500 annual maximum, with no copay and no coinsurance for most preventive and comprehensive care, though prosthodontics require a 30% coinsurance with no copay and Medicare-covered dental has a $35 copay with no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H6622-001 (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H6622-001 (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered under Humana Gold Plus H6622-001 (HMO), with durable medical equipment, prosthetics, and medical supplies requiring a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts have a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H6622-001 (HMO) covers diagnostic and radiological services, requiring prior authorization for both. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $90 copay for procedures, while radiological services include outpatient X-rays with no copay and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Humana Gold Plus H6622-001 (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H6622-001 (HMO) covers some cardiac rehabilitation services with no copay or coinsurance, though prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H6622-001 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copayment for days 1 through 20 and a $218 daily copayment for days 21 through 100. Prior authorization is required, and while the plan allows admission with less than a three-day inpatient hospital stay, additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Humana Gold Plus H6622-001 (HMO) provides partial coverage for other services, excluding Dual Eligible SNPs with Highly Integrated Services and other unspecified services. Covered benefits include acupuncture with a $35 copay and no coinsurance (limited to 20 treatments per year), as well as over-the-counter items and chronic illness meals which both have no copay and no coinsurance.
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