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Humana Gold Plus H6622-028 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-028 (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 H6622-028 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H6622-028 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Clark and Nye Counties. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H6622-028 (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 H6622-028 (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 H6622-028 (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 $5.00. 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 $250.00 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 $2700.00 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 H6622-028 (HMO) plan has a $250 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs, you'll pay a $10 copay at preferred mail order pharmacies and a $10 copay at standard pharmacies. For standard generic drugs, the copay is $47.00. For preferred brand drugs, you will pay 40% coinsurance, and for non-preferred drugs, you will pay 30% coinsurance. Once your out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H6622-028 (HMO) plan offers a range of benefits, including inpatient hospital stays with a $150 copay for the first six days, and no copay thereafter. The plan also covers a variety of outpatient services, primary care visits with no copay, and specialist visits with a $20 copay. Additional benefits include coverage for emergency services, hearing and vision services, and dental services. You'll also find coverage for home health services, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient hospital services, including acute and psychiatric care, are covered with a $150 copay for days 1-6, and no copay for days 7-90. Additional days for inpatient hospital-acute are covered with no copay. Non-Medicare-covered stays and upgrades for inpatient hospital-acute, and additional days and non-Medicare-covered stays for inpatient hospital-psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $50, Observation Services with a $150 copay, Ambulatory Surgical Center (ASC) Services with no copay, Individual and Group Sessions for Outpatient Substance Abuse with a copay between $10 and $30, and Outpatient Blood Services with no copay. All services require prior authorization and a doctor referral.
Partial Hospitalization See details
Partial Hospitalization is covered, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus H6622-028 (HMO) plan. Ground ambulance services have a copay of $315, while air ambulance services have a copay of $630, and both have no coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Humana Gold Plus H6622-028 (HMO) plan. Emergency Services have a $140 copay, Urgently Needed Services have a $25 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $140 copay. There is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services are covered with no copay. Chiropractic Services require a referral and prior authorization and have a $20 copay. Occupational Therapy Services require prior authorization and a referral, with a $30 copay. Physician Specialist Services require prior authorization and a referral, with a $20 copay. Mental Health Specialty Services, including individual and group sessions, have a $10 copay. Podiatry Services, including routine foot care, have a $20 copay. Other Health Care Professional services have a copay between $0 and $20. Psychiatric Services, including individual and group sessions, have a $10 copay. Physical Therapy and Speech-Language Pathology Services have a $30 copay and require prior authorization and a referral. Additional Telehealth Benefits have a copay between $0 and $25. Opioid Treatment Program Services have a copay between $10 and $30.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams with no copay, and additional preventive services, with no copay for Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services with the Humana Gold Plus H6622-028 (HMO) plan includes hearing exams with a $20 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered; all types have a copay between $399 and $999. OTC hearing aids are also covered, up to $30 every three months.
Vision Services See details
The Humana Gold Plus H6622-028 (HMO) plan covers vision services, including eye exams with a copay of $0 - $20, and eyewear with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan covers one routine eye exam and one pair of contact lenses or eyeglasses (lenses and frames) every year.
Dental Services See details
The Humana Gold Plus H6622-028 (HMO) plan covers Medicare Dental Services with a $20 copay, and other dental services including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services with no copay. Fluoride treatments, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H6622-028 (HMO) plan. You will pay a coinsurance of 20% for these services, and prior authorization and a doctor referral are required.
Medical Equipment See details
Medical Equipment is covered by Humana Gold Plus H6622-028 (HMO), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance. Medical Supplies have no copay, while Diabetic Supplies have no copay, and a coinsurance between 10% and 20%.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, and lab services. Diagnostic procedures/tests have a copay between $0 and $50, while lab services and outpatient X-ray services have no copay. Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H6622-028 (HMO) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H6622-028 (HMO) plan, with a $20 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus H6622-028 (HMO) plan covers acupuncture with a $20 copay, and covers OTC items with a maximum benefit coverage amount of $30 every three months, and a meal benefit with no copay. This plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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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