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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 2026, 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-Tidewater 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 H6622-004 (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 $1.00. 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 $4900.00 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) prescription drug plan features an annual drug deductible of $350. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications carry a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, with no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and mail order, while a 3-month supply costs $131 through preferred mail order. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring 43% coinsurance and Tier 5 specialty drugs requiring 29% coinsurance. Understanding these tier-based copays and coinsurance rates helps you estimate your annual out-of-pocket prescription costs with this Humana plan.
Additional Benefits
The Humana Gold Plus H6622-004 (HMO) plan offers affordable medical coverage with no copay or coinsurance for primary care visits, home health services, and routine preventive care. Specialist visits require a low $10 copay, while inpatient hospital stays have a $345 daily copay for the first several days with no copay for the remaining covered days. Emergency room visits feature a $130 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also features extensive dental, vision, and hearing benefits, including no copay for routine annual eye and hearing exams. Dental services offer no copay for preventive and comprehensive care up to a $3,000 annual limit, while routine eyewear is covered with no copay up to a $350 yearly allowance. Additionally, members can access over-the-counter health items and home-delivered meals with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus H6622-004 (HMO) covers inpatient hospital services with no coinsurance, requiring a $345 daily copay for days 1 through 8 of acute stays and days 1 through 6 of psychiatric stays, with no copay for remaining covered days. Prior authorization is required, and certain services like hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Gold Plus H6622-004 (HMO) with no coinsurance, though prior authorization is required. Ambulatory surgical center and blood services feature no copay, outpatient hospital services have a copay ranging from $0 to $450 (with a $345 copay per stay for observation services), and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Gold Plus H6622-004 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus H6622-004 (HMO) partially covers ambulance and transportation services, offering ground and air ambulance services with a $335 copay and no coinsurance. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
Humana Gold Plus H6622-004 (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency, urgent care, and emergency transportation are also covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H6622-004 (HMO) covers primary care physician visits with no copay and no coinsurance, while specialist visits require a $10 copay and no coinsurance. Additional services like physical therapy, occupational therapy, and mental health sessions have copays ranging from $25 to $35 with no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Humana Gold Plus H6622-004 (HMO) partially covers preventive services with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and memory fitness. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems, nutritional/dietary benefits, and weight management programs.
Hearing Services See details
Hearing services are covered by Humana Gold Plus H6622-004 (HMO), featuring a $10 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with no coinsurance and copays between $499 and $1,099, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by Humana Gold Plus H6622-004 (HMO) with no deductible or coinsurance, featuring no copay for one annual routine eye exam and no copay for eyewear up to a $350 yearly limit. This benefit is partially covered, as other eye exams, individual eyeglass lenses, individual frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H6622-004 (HMO) dental services are partially covered, offering Medicare-covered dental care with a $10 copay and no coinsurance, alongside other covered preventive and comprehensive services with no copay and no coinsurance up to a $3,000 annual limit. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus H6622-004 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H6622-004 (HMO) plan, subject to prior authorization. Patients are responsible for a $30 copayment and 20% coinsurance for these services.
Medical Equipment See details
Humana Gold Plus H6622-004 (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and 10% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay along with applicable coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H6622-004 (HMO) covers diagnostic and radiological services with prior authorization required, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $120, while therapeutic radiological services require a minimum 20% coinsurance and a minimum $10 copay.
Home Health Services See details
Humana Gold Plus H6622-004 (HMO) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Humana Gold Plus H6622-004 (HMO) with no coinsurance and require prior authorization, but only some services are covered. Standard cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($35 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Gold Plus H6622-004 (HMO) with no coinsurance, featuring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Other services covered by Humana Gold Plus H6622-004 (HMO) include acupuncture for a $10 copay and no coinsurance, limited to 20 treatments per year. Over-the-counter (OTC) items and meal benefits are also covered with no copay and no coinsurance, though some CMS OTC list items are excluded and prior authorization is required for acupuncture and meals.
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