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Humana Gold Plus H6622-004 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-004 (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 H6622-004 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H6622-004 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Richmond. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H6622-004 (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 H6622-004 (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 H6622-004 (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 $350.00 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 H6622-004 (HMO) plan has a $350 deductible for prescription drugs. After the deductible, you'll pay varying copays or coinsurance amounts depending on the drug tier and pharmacy you use. For instance, in the initial coverage phase, you may pay a $5 copay for preferred generic drugs at a standard or preferred mail pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The Humana Gold Plus H6622-004 (HMO) plan offers a range of benefits, including inpatient hospital care with a copay, and outpatient services with varying copays. The plan also covers emergency services, primary care with no copay for some services, and preventive services with no copay for annual physical exams. Additional benefits include hearing and vision services, dental services with a maximum benefit, and coverage for home infusion, dialysis, and medical equipment with coinsurance. This plan also provides coverage for ambulance services, acupuncture, and OTC items, but has limitations on other services like transportation and certain therapies.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Humana Gold Plus H6622-004 (HMO) plan. For acute care, there is a $399 copay for days 1-6, and no copay for days 7-90, while psychiatric care has a $399 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services include outpatient hospital services with a copay between $0 and $450, observation services with a $399 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $45 and $100 for individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H6622-004 (HMO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
For Humana Gold Plus H6622-004 (HMO), Ambulance Services are covered with a $315 copay for both Ground and Air Ambulance Services, and no coinsurance; however, Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all have no coinsurance.
Primary Care See details
The Humana Gold Plus H6622-004 (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $15 copay, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. The plan also covers Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services with a $45 copay for individual and group sessions, and Additional Telehealth Benefits with a copay between $0 and $45. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered by the Humana Gold Plus H6622-004 (HMO) plan. Annual physical exams have no copay. Other services, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Humana Gold Plus H6622-004 (HMO) covers hearing exams with a $15 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, but prescription hearing aids are partially covered, and OTC hearing aids are covered up to $50 every three months. Prescription hearing aids have a copay between $599 and $899.
Vision Services See details
The Humana Gold Plus H6622-004 (HMO) plan covers vision services, including routine eye exams with a copay between $0 and $15, and eyewear with no copay, up to a combined maximum of $350 per year. Eyeglass lenses, eyeglass frames and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H6622-004 (HMO) plan covers Medicare Dental Services with a $15 copay, and other dental services with a $2,500 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with 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, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, and coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H6622-004 (HMO) plan and require prior authorization. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Diabetic Supplies have a 10%-20% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus H6622-004 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $120, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, and Therapeutic Radiological Services have a copay up to $15 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H6622-004 (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 by Humana Gold Plus H6622-004 (HMO), but the specific services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H6622-004 (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H6622-004 (HMO) plan covers acupuncture with a $15 copay, up to 20 treatments per year with prior authorization, and also covers over-the-counter (OTC) items up to $50 every three months. This plan also provides a meal benefit with no copay for chronic illness. However, this plan does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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