A non-government entity
Humana Gold Plus H6622-035 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-035 (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 H6622-035 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H6622-035 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in South Central Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H6622-035 (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 H6622-035 (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 H6622-035 (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 $3.00. 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 $300.00 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 $9350.00 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:
Sign up for Humana Gold Plus H6622-035 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Gold Plus H6622-035 (HMO) plan has a $300 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs at a standard pharmacy, you will pay a $5 copay. For preferred brand drugs, you will pay 38% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus H6622-035 (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays, outpatient services, and emergency services. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental services, with varying copays for each. This plan also provides coverage for ambulance and transportation services. Additional benefits include home health services with no copay, and coverage for home infusion services and dialysis services with coinsurance. The plan also covers medical equipment, diagnostic and radiological services, and skilled nursing facility services. Other services such as acupuncture and over-the-counter items are covered.
Inpatient Hospital See details
Inpatient hospital stays, including acute and psychiatric care, are covered, but require prior authorization. For days 1-7 of an inpatient stay, there is a $290 copay, and for days 8-90, there is no copay. Additional days for acute inpatient hospital stays are covered with no copay.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $275, observation services with a $290 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay between $35 and $85 for both individual and group sessions, and outpatient blood services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H6622-035 (HMO) plan. This benefit has a $55 copay and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $315 copay, and transportation services to a plan-approved health-related location have no copay. 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 by the Humana Gold Plus H6622-035 (HMO) plan. Emergency Services has a $110 copay and no coinsurance, Urgently Needed Services has a $45 copay and no coinsurance, and Worldwide Emergency Services has a $110 copay and no coinsurance for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Gold Plus H6622-035 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a $20-$35 copay. The plan also covers physician specialist services with a $35 copay, mental health specialty services with a $35 copay for individual and group sessions, and physical therapy and speech-language pathology services with a $20-$35 copay. Additional telehealth benefits have a $0-$45 copay, and opioid treatment program services have a $35-$85 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services. Annual physical exams have no copay, while the additional preventive services, fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
The Humana Gold Plus H6622-035 (HMO) plan covers hearing exams with a $35 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with copays between $199 and $499, while OTC hearing aids are covered up to $15 per month.
Vision Services See details
The Humana Gold Plus H6622-035 (HMO) plan covers vision services, including routine eye exams with a copay between $0 and $35, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, and no copay for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics fixed, and oral and maxillofacial surgery. Fluoride treatment, prosthodontics removable, maxillofacial prosthetics, implant services, and orthodontics are not covered. The plan also covers orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H6622-035 (HMO) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 17% coinsurance, Prosthetics/Medical Supplies with a 20% coinsurance, and Diabetic Equipment with a 10% coinsurance for Diabetic Supplies and a $10 copay for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus H6622-035 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $105, Lab Services have no copay, and Outpatient X-Ray Services have no copay. Diagnostic Radiological Services have a maximum copay of $325, and Therapeutic Radiological Services have a copay of at most $35 and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H6622-035 (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H6622-035 (HMO) plan. Although the plan covers Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, these services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H6622-035 (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H6622-035 (HMO) plan covers acupuncture with a $35 copay, and covers over-the-counter items with a $15 monthly maximum benefit, and covers 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, or Self-Directed Personal Assistance Services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved