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Humana Gold Plus H6622-037 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-037 (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 H6622-037 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H6622-037 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Greater Philadelphia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H6622-037 (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 H6622-037 (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 H6622-037 (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 $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 $8900.00 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 H6622-037 (HMO) plan has a $300 deductible for prescription drugs. After the deductible is met, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you'll pay a $5 copay for preferred generic drugs at preferred pharmacies and a $47 copay for standard generic drugs. For preferred brand drugs, you'll pay 40% coinsurance. After 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 H6622-037 (HMO) plan offers a range of benefits with varying costs. You can expect no copay for primary care, preventive services, home health services, and many outpatient services. The plan has copays for inpatient hospital stays, specialist visits, and other services, along with coinsurance for some services such as dialysis, medical equipment, and home infusion. The plan also covers hearing, vision, and dental services, with copays and annual limits.
Inpatient Hospital See details
Inpatient Hospital benefits with the Humana Gold Plus H6622-037 (HMO) plan include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $330 copay for days 1-8 and no copay for days 9-90; additional days have no copay. Inpatient Hospital Psychiatric services have a $250 copay for days 1-8 and no copay for days 9-90. 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 $600, Observation Services with a $330 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. Prior authorization is required for all of these services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H6622-037 (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
The Humana Gold Plus H6622-037 (HMO) plan covers ambulance services with a $315 copay for both ground and air ambulance services, and transportation services to plan-approved health-related locations with no copay for up to 24 one-way trips per year, but transportation to any health-related location is not covered. There is no coinsurance for any of these services.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and there is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H6622-037 (HMO) plan covers Primary Care Physician Services with no copay, and Chiropractic Services with a $15 copay. Occupational Therapy Services have a copay between $20 and $30, and Physician Specialist Services have a $25 copay. Mental Health and Psychiatric Services, as well as Opioid Treatment Program Services, have a copay between $30 and $80, while Physical Therapy and Speech-Language Pathology Services have a copay between $20 and $30. Other Health Care Professional services have a copay between $0 and $25, and Additional Telehealth Benefits have a copay between $0 and $45. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, an annual physical exam with no copay, and additional preventive services, though some specific services like Health Education, In-Home Safety Assessments, and others are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay. Routine hearing exams are covered with no copay, and fitting/evaluation for hearing aids are covered with no copay. Prescription Hearing Aids are partially covered, with Prescription Hearing Aids (all types) costing between $199 and $499, and Prescription Hearing Aids for inner ear, outer ear, and over the ear are not covered. OTC Hearing Aids are covered with a maximum benefit of $15 per month.
Vision Services See details
Vision services include eye exams with a copay between $0 and $25, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered, and there is a combined maximum of $300 for eyewear every year.
Dental Services See details
The Humana Gold Plus H6622-037 (HMO) plan covers Medicare Dental Services with a $25 copay, and other dental services with a $1,500 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, and prosthodontics (fixed) are covered with no copay, while fluoride treatment, prosthodontics (removable), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H6622-037 (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H6622-037 (HMO) plan, with a coinsurance between 20% and 20%. Prior authorization is required.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, and Medical Supplies, is covered by the Humana Gold Plus H6622-037 (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance with prior authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Supplies have a 10% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Humana Gold Plus H6622-037 (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $105, Lab Services have no copay, Diagnostic Radiological Services have a maximum copay of $325, Therapeutic Radiological Services have a copay of at least $30 and a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H6622-037 (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 H6622-037 (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, with prior authorization required. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The Humana Gold Plus H6622-037 (HMO) plan covers acupuncture with no copay, up to 12 treatments per year, and also covers over-the-counter items, including nicotine replacement therapy and naloxone, with a maximum benefit of $15.00 per month. The plan also covers a meal benefit with no copay. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.
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