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Humana Gold Plus H6622-026 (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-026 (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus H6622-026 (HMO-POS) in 2026, please refer to our full plan details page.
Humana Gold Plus H6622-026 (HMO-POS) is a HMO-POS plan offered by Humana Inc. available for enrollment in 2025 to people living in Western North Carolina 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 H6622-026 (HMO-POS) 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 H6622-026 (HMO-POS).
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 H6622-026 (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $34.80. 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 $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 $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.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Humana Gold Plus H6622-026 (HMO-POS) prescription drug plan features an annual drug deductible of $350. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic medications cost a $5 copay for a 1-month supply at standard pharmacies, 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 options. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 47% coinsurance, and Tier 5 specialty drugs have a 29% coinsurance for a 1-month supply.
Additional Benefits
The Humana Gold Plus H6622-026 (HMO-POS) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care physician visits and home health services. For specialist visits, emergency care, and inpatient hospital stays, members will pay set copayments, such as a $25 specialist copay or a $115 emergency room copay. Most covered services require no coinsurance, though durable medical equipment and dialysis require a 20% coinsurance. This plan also includes valuable routine benefits to support your everyday wellness, including preventive care, vision, and dental services with no copay. Members can take advantage of routine eye exams, routine dental care up to a $2,000 yearly limit, and routine hearing exams with no copay or coinsurance. Prescription hearing aids are also covered with copays ranging from $199 to $499.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Gold Plus H6622-026 (HMO-POS) with no coinsurance, requiring a $375 daily copay for days 1-7 of acute stays (with no copay for days 8 and beyond) and days 1-5 of psychiatric stays (with no copay for days 6-90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the Humana Gold Plus H6622-026 (HMO-POS) plan are covered with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
Humana Gold Plus H6622-026 (HMO-POS) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H6622-026 (HMO-POS) covers Medicare-covered ground and air ambulance services with a $335 copay and no coinsurance, requiring prior authorization. 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
Emergency Services under Humana Gold Plus H6622-026 (HMO-POS) are covered with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits under Humana Gold Plus H6622-026 (HMO-POS) are partially covered, as podiatry and chiropractic services are not covered. Covered primary care physician visits have no copay and no coinsurance, while specialist and therapy services require a $25 copay and no coinsurance, and mental health services require a $35 copay and no coinsurance.
Preventive Services See details
Humana Gold Plus H6622-026 (HMO-POS) offers partially covered preventive services with no copays and no coinsurance for annual physical exams, kidney disease education, and select screenings like glaucoma and diabetes self-management training. However, several supplemental benefits are not covered, including health education, in-home safety assessments, personal emergency response systems, nutritional therapy, and weight management programs.
Hearing Services See details
Humana Gold Plus H6622-026 (HMO-POS) offers partially covered hearing services, featuring a $25 copay and no coinsurance for Medicare-covered exams, and routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $199 to $499 and no coinsurance, while OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Humana Gold Plus H6622-026 (HMO-POS) vision services are partially covered with no deductibles and no coinsurance. Routine eye exams and covered eyewear (one pair of contact lenses or eyeglasses per year up to a $150 limit) are provided with no copay, while other eye exam services, separate eyeglass lenses, separate frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H6622-026 (HMO-POS) offers partially covered dental services, featuring a $25 copay and no coinsurance for Medicare-covered dental, and other dental services with no copay and no coinsurance up to a $2,000 yearly maximum. While most preventive and comprehensive services are covered with no copay and no coinsurance, fluoride treatments, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H6622-026 (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H6622-026 (HMO-POS) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Humana Gold Plus H6622-026 (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with 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 require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Humana Gold Plus H6622-026 (HMO-POS) with prior authorization, featuring no coinsurance for diagnostic services, no copay for lab services or outpatient X-rays, and a $0 to $120 copay for diagnostic procedures. Diagnostic radiology has a $0 minimum copay, while therapeutic radiology requires a minimum $25 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H6622-026 (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered with no coinsurance under the Humana Gold Plus H6622-026 (HMO-POS) plan, though prior authorization is required. While some services are covered, specific options like cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and SET for PAD services ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H6622-026 (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Humana Gold Plus H6622-026 (HMO-POS) partially covers other services, which includes acupuncture for a $25 copay and no coinsurance (up to 20 treatments per year) and chronic illness meal benefits with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this benefit.
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