Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) in 2026, please refer to our full plan details page.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Ohio. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
For Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.40. 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 $9250.00 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.
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The Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. Beneficiaries pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications when using a standard pharmacy or preferred mail order for both 1-month and 3-month supplies. Standard mail order fills for these generic tiers require a copay, starting at $10 for Tier 1 and $20 for Tier 2 for a 1-month supply. For Tier 3 (Preferred Brand), Tier 4 (Non-Preferred Drug), and Tier 5 (Specialty Tier) medications, the plan requires a 25% coinsurance across standard pharmacies, preferred mail order, and standard mail order options. This 25% coinsurance applies to 1-month and 3-month supplies for Tiers 3 and 4, and to 1-month supplies for Tier 5 specialty drugs. This plan provides an affordable way to manage generic prescription costs while offering predictable coinsurance for brand-name and specialty medications.
The Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) offers comprehensive medical coverage with no copay for primary care, specialists, and outpatient services, though a 20% coinsurance applies to these visits. For inpatient hospital stays, members pay no coinsurance but are responsible for a copay of $2,230 per acute care stay or $2,080 per psychiatric stay. Emergency room visits carry a $115 copay, which is waived upon admission, while routine preventive services and home health care are fully covered with no copay and no coinsurance. Supplemental benefits include dental coverage up to $4,000 annually and vision coverage for eyewear up to $1,400, both with no copays. Routine hearing exams and durable medical equipment are covered with no copay and a 20% coinsurance, and the plan provides up to 60 one-way transportation trips per year with no copay or coinsurance. Additionally, skilled nursing facility stays require no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a copay of $2,230 per stay for acute care and $2,080 per stay for psychiatric care, both of which require prior authorization. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers outpatient services with no copay and a 20% coinsurance, which applies to outpatient hospital, ambulatory surgical center, outpatient substance abuse, and outpatient blood services. Prior authorization is required for these services, and there is no deductible for outpatient blood services.
Partial hospitalization is covered by the Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered with no copay and no coinsurance for up to 60 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a 20% coinsurance (up to a $40 maximum) and no copay, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers primary care, specialist, mental health, therapy, and telehealth services with no copay and a 20% coinsurance, though prior authorization is required for most specialist and therapy services. Podiatry services and routine chiropractic care are not covered by this plan.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers preventive services with no copays and no coinsurance, including annual physical exams, kidney disease education, and diabetes training. While certain supplemental services like memory fitness, smoking cessation counseling, and wigs (up to $500 annually) are covered, other sub-services such as health education, nutritional therapy, and in-home safety assessments are not covered.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers hearing services with no deductible, offering routine hearing exams once per year with a 20% coinsurance and no copay, alongside unlimited hearing aid fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance for up to two devices every three years (excluding inner ear, outer ear, and over the ear models), while unlimited OTC hearing aids are covered with no copay and no coinsurance.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) offers vision benefits with no deductibles, no copays, and a 20% coinsurance for routine eye exams and contact lenses. While eyeglasses and contact lenses are covered up to a combined maximum of $1,400, other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) offers partially covered dental services with no copay and a 20% coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $4,000 annual limit. While a wide range of services are covered, fixed prosthodontics are not covered.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers home infusion bundled services with prior authorization, though step therapy may apply. Covered Medicare Part B drugs, including chemotherapy and insulin, require no coinsurance to 20% coinsurance and feature no copay, except for insulin which has a $35 copay.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical equipment is covered by Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) with a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic supplies. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and radiological services are covered by Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) with a 20% coinsurance and prior authorization required. Diagnostic tests, procedures, and lab services require no copay, while outpatient X-rays carry a $50 copay and diagnostic radiological services require a $200 copay.
Home Health Services are covered under the Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) plan with no copay and no coinsurance. Prior authorization is required to access these services.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers some cardiac rehabilitation services with no copay and no coinsurance, subject to prior authorization. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, carrying a 17% to 20% coinsurance.
Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day limit are not covered.
Other services are partially covered by Humana Gold Plus SNP-DE H6622-015 (HMO D-SNP), including acupuncture with no copay and 20% coinsurance, as well as over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Highly integrated services for dual eligible SNPs are not covered, and prior authorization is required for acupuncture and meal benefits.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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