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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 2026, 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 2026.
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 $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 $8250.00 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) prescription drug plan features an annual drug deductible of $615. Tier 1 preferred generic drugs offer excellent savings with no copay for a 1-month or 3-month supply at standard pharmacies and preferred mail-order services. Tier 2 generic drugs are also highly affordable, costing just $5 for a 1-month supply at standard pharmacies, or no copay for a 3-month supply when using preferred mail order. For brand-name and higher-tier medications, Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with 3-month mail-order options ranging from $131 to $141. Tier 4 non-preferred drugs and Tier 5 specialty drugs transition to coinsurance, requiring 48% and 25% coinsurance respectively. This clear cost structure helps beneficiaries understand their out-of-pocket expenses when choosing the Humana Gold Plus H6622-036 (HMO) plan.
Additional Benefits
The Humana Gold Plus H6622-036 (HMO) plan offers comprehensive medical coverage with no copay for primary care visits, annual physical exams, and home health services. Specialist visits require a budget-friendly $25 copay, while inpatient hospital stays require a daily copay of $295 for the first eight days. Emergency room visits carry a $115 copay, which is waived upon admission, and urgent care visits require a $40 copay. Additional everyday benefits include no copay for routine dental, vision, and hearing exams, alongside a $250 annual allowance for glasses or contacts and up to $1,000 in yearly dental coverage. Members also benefit from no copay for over-the-counter items and up to 24 one-way trips to plan-approved locations. For specialized needs, durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Gold Plus H6622-036 (HMO) inpatient hospital benefits are partially covered with no coinsurance, requiring a daily copay of $295 for days 1-8 of acute stays and $240 for days 1-8 of psychiatric stays, followed by no copay for remaining covered days. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H6622-036 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay ranging from $0 to $400, while observation services cost a $295 copay per stay and outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus H6622-036 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Gold Plus H6622-036 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance per trip. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to other health-related locations is not covered.
Emergency Services See details
Humana Gold Plus H6622-036 (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance, with no deductibles applying to these benefits.
Primary Care See details
Humana Gold Plus H6622-036 (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $25 copay and no coinsurance. Additional covered services, such as physical therapy, mental health, telehealth, and opioid treatment, carry copays ranging from $0 to $40 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H6622-036 (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are only partially covered, excluding services such as health education, in-home safety assessments, personal emergency response systems, nutritional/dietary benefits, and counseling.
Hearing Services See details
Humana Gold Plus H6622-036 (HMO) covers hearing services, featuring a $25 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for routine exams, hearing aid fittings, and OTC hearing aids. Prescription hearing aids are partially covered with no coinsurance and copays up to $299, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Gold Plus H6622-036 (HMO) provides partially covered vision services with no coinsurance, featuring no copay for one routine annual eye exam and no copay for eyeglasses or contact lenses up to a $250 yearly limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H6622-036 (HMO) partially covers dental services, offering no copay and no coinsurance for most preventive, diagnostic, and comprehensive services up to a $1,000 annual maximum, while Medicare-covered dental requires a $25 copay and no coinsurance. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Gold Plus H6622-036 (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Medicare Part B insulin carries a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H6622-036 (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H6622-036 (HMO) 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 and no coinsurance.
Diagnostic and Radiological Services See details
Humana Gold Plus H6622-036 (HMO) covers diagnostic and radiological services with prior authorization required. Lab services feature no copay and no coinsurance, diagnostic procedures carry no coinsurance and a copay of up to $105, and therapeutic radiological services require a minimum $30 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Gold Plus H6622-036 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H6622-036 (HMO) covers cardiac rehabilitation services with no coinsurance, though prior authorization is required. Members will pay a $30 copay for cardiac and intensive cardiac rehabilitation, and a $10 copay for pulmonary rehabilitation and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H6622-036 (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus H6622-036 (HMO), excluding dual eligible SNPs and other unspecified services. Acupuncture is covered with a $25 copay and no coinsurance, while over-the-counter items and chronic illness meal benefits are offered with no copay and no coinsurance.
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