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Humana Gold Plus H6622-033 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-033 (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 H6622-033 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H6622-033 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Tulsa Metro. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H6622-033 (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 H6622-033 (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 H6622-033 (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 $2.00. 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 $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 $4225.00 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 H6622-033 (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing a $5 copay for a 1-month supply and no copay for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, though choosing a 3-month preferred mail order lowers the cost to a $131 copay. For higher-tier medications, members pay coinsurance instead of copays, including a 47% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. These structured costs help Medicare beneficiaries plan their annual healthcare expenses effectively.
Additional Benefits
The Humana Gold Plus H6622-033 (HMO) offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. Specialists require a $30 copay, while inpatient hospital stays cost a $295 daily copay for the first six days and no copay thereafter. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes routine dental, vision, and hearing benefits with no copay up to specified annual limits, alongside coverage for over-the-counter items. For specialized needs, durable medical equipment and dialysis services require a 20% coinsurance with no copay. Additionally, prescription hearing aids and selective dental procedures are partially covered with specific copayments.
Inpatient Hospital See details
Humana Gold Plus H6622-033 (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $295 daily copay for days 1 to 6 and no copay for days 7 to 90. While unlimited additional acute care days are covered at no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Gold Plus H6622-033 (HMO) covers outpatient services with no coinsurance, though prior authorization is required. Outpatient hospital visits have a copay of $0 to $275, observation services cost a $295 copay per stay, outpatient substance abuse sessions carry a $30 to $35 copay, and both ambulatory surgical center and blood services are covered with no copay.
Partial Hospitalization See details
Humana Gold Plus H6622-033 (HMO) covers partial hospitalization services with a $25 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Humana Gold Plus H6622-033 (HMO) covers Medicare-approved ground and air ambulance services with a $335 copay and no coinsurance, requiring prior authorization. Transportation services are not covered by this plan, including trips to plan-approved or health-related locations.
Emergency Services See details
Humana Gold Plus H6622-033 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H6622-033 (HMO) primary care benefits include primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, and speech therapy services require a $25 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H6622-033 (HMO) covers preventive services, including annual physical exams, kidney disease education, and screenings for glaucoma and diabetes, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering a memory fitness program with no copay and no coinsurance, while services such as health education, in-home safety assessments, personal emergency response systems, and nutritional therapy are not covered.
Hearing Services See details
Humana Gold Plus H6622-033 (HMO) covers Medicare-covered hearing exams for a $30 copay and routine exams, fitting evaluations, and OTC hearing aids with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay between $699 and $999 and no coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Gold Plus H6622-033 (HMO) vision benefits are partially covered, offering one routine eye exam per year and eyewear with no copay and no coinsurance, up to a $250 annual maximum. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H6622-033 (HMO) partially covers dental services, offering Medicare-covered dental care with a $30 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $1,500 yearly maximum. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H6622-033 (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and radiation, carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Humana Gold Plus H6622-033 (HMO) plan with a 20% coinsurance and no copay, though prior authorization is required.
Medical Equipment See details
Humana Gold Plus H6622-033 (HMO) covers durable medical equipment (DME) and prosthetics 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
Humana Gold Plus H6622-033 (HMO) covers diagnostic and radiological services with prior authorization, featuring no copay for lab services and outpatient X-rays. Diagnostic procedures and tests carry a 20% coinsurance and a copay ranging from $0 to $80, while therapeutic radiological services require a 20% coinsurance and a minimum copay of $30.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H6622-033 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Humana Gold Plus H6622-033 (HMO) with no copay and no coinsurance, although prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H6622-033 (HMO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, though a prior three-day hospital stay is not, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Humana Gold Plus H6622-033 (HMO) covers acupuncture with a $30 copay and no coinsurance for up to 20 treatments per year, requiring prior authorization. Over-the-counter (OTC) items and eligible meal benefits are also covered with no copay and no coinsurance.
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