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Humana Gold Plus H6622-036 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-036 (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 H6622-036 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H6622-036 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Northeast 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 H6622-036 (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 H6622-036 (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 H6622-036 (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 $1.00. 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:
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Drug Coverage
The Humana Gold Plus H6622-036 (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 used. For example, for a standard pharmacy, you will pay a $5 copay for tier 1 preferred generic drugs, a $47 copay for tier 2 standard generic drugs, and 45% coinsurance for tier 3 preferred brand drugs. 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 H6622-036 (HMO) plan offers a wide range of benefits with varying costs. This plan includes coverage for inpatient hospital stays, outpatient services, and emergency services, with copays ranging from $0 to $345 depending on the specific service. Preventive, hearing, vision, and dental services are also included, with routine eye exams and many dental services available with no copay. The plan also covers home health services with no copay, and offers additional benefits like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a copay of $295 for days 1-8, and no copay for days 9-90, as well as Inpatient Hospital Psychiatric with a copay of $240 for days 1-8, and no copay for days 9-90. Additional Days for Inpatient Hospital-Acute are covered with no copay for days 91-999. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $345, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a copay between $30 and $80 for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H6622-036 (HMO) plan, and requires prior authorization. You will have a $55 copay for this benefit.
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, while transportation services to a plan-approved health-related location have a 24-trip limit per year with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all have no coinsurance.
Primary Care See details
The Humana Gold Plus H6622-036 (HMO) plan offers Primary Care benefits, with no copay for Primary Care Physician services. Chiropractic services have a $15 copay, while Occupational Therapy Services have a copay between $20 and $30. Physician Specialist Services have a $30 copay, and Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a minimum copay of $30. Physical Therapy and Speech-Language Pathology Services have a copay between $20 and $30. Additional Telehealth Benefits have a copay between $0 and $45.
Preventive Services See details
The Humana Gold Plus H6622-036 (HMO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services such as Health Education, In-Home Safety Assessment, and others are not covered, but other services like Glaucoma Screening, Diabetes Self-Management Training, and Barium Enemas have no copay.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, routine hearing exams with no copay, fitting/evaluation for hearing aids with no copay, prescription hearing aids with a copay between $199 and $499, and OTC hearing aids with a maximum benefit of $15 per month. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Humana Gold Plus H6622-036 (HMO) plan covers vision services including routine eye exams with a copay of $0, and eyewear with a copay of $0 for contact lenses and eyeglasses (lenses and frames), with a combined maximum of $150 per year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered. You can get one routine eye exam and one pair of contact lenses or eyeglasses (lenses and frames) per year.
Dental Services See details
Dental Services are covered, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and oral and maxillofacial surgery, each with no copay; fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare Dental Services have a $30 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and between 0-20% coinsurance, while other Medicare Part B drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H6622-036 (HMO) plan, but require prior authorization. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by this plan. DME has a 20% coinsurance and requires prior authorization, and Prosthetic Devices and Medical Supplies have a 20% coinsurance. For Diabetic Supplies, you'll pay a 10% coinsurance and no copay, and for Diabetic Therapeutic Shoes/Inserts, there's a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services. Diagnostic procedures/tests have a copay between $0 and $105, and lab services have no copay. Diagnostic radiological services have a copay of up to $300, and therapeutic radiological services have a coinsurance of at least 20% and a copay of at least $30. Outpatient X-Ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H6622-036 (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 by the Humana Gold Plus H6622-036 (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H6622-036 (HMO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
Other Services includes acupuncture with a $30 copay, over-the-counter items with a $15 monthly benefit, and a meal benefit with no copay. Also included are additional services that are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services.
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