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Humana Gold Plus H6622-054 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-054 (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 H6622-054 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus H6622-054 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Western 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 H6622-054 (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 H6622-054 (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 H6622-054 (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 $7950.00 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 H6622-054 (HMO) plan features a $615 annual drug deductible. Under this plan, Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost as low as a $5 copay for a 1-month supply, with no copay for a 3-month supply when using preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply across standard pharmacies and mail order options. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance.
Additional Benefits
The Humana Gold Plus H6622-054 (HMO) plan offers comprehensive coverage with predictable cost-sharing, including no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $30 copay, while inpatient hospital stays feature a $290 daily copay for the first several days followed by no copay for subsequent days. Outpatient procedures, emergency care, and diagnostic testing are also covered with clear copays and no coinsurance. This plan also includes valuable supplemental benefits, such as routine dental, vision, and hearing services with no copay, including a $250 annual eyewear allowance and a $3,000 dental limit. Additionally, members can access up to 24 one-way transportation trips per year, over-the-counter items, and chronic illness meals with no copay. Medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital care is partially covered by Humana Gold Plus H6622-054 (HMO) with no coinsurance, requiring a $290 daily copay for days 1-7 of acute stays and days 1-6 of psychiatric stays, with no copay for subsequent covered days. Prior authorization is required, and excluded sub-services include upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
Humana Gold Plus H6622-054 (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $500, observation services have a $290 copay per stay, and outpatient substance abuse sessions require a $30 to $35 copay.
Partial Hospitalization See details
Humana Gold Plus H6622-054 (HMO) covers partial hospitalization with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Humana Gold Plus H6622-054 (HMO) plan, featuring a $335 copay and no coinsurance for both ground and air ambulance services. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
Humana Gold Plus H6622-054 (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H6622-054 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Covered therapy, mental health, and telehealth services feature copays ranging from $0 to $40 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Gold Plus H6622-054 (HMO) offers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Additional supplemental preventive benefits are only partially covered, featuring a memory fitness benefit with no copay, while services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Humana Gold Plus H6622-054 (HMO) covers hearing exams, including Medicare-covered exams for a $30 copay and no coinsurance, alongside routine exams and fitting evaluations for no copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $0 to $299 and no coinsurance—excluding inner ear, outer ear, and over-the-ear models—while over-the-counter hearing aids are fully covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H6622-054 (HMO), offering no copay, no coinsurance, and no deductible for one routine eye exam and select eyewear up to a $250 annual limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H6622-054 (HMO) partially covers dental services, featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $3,000 annual limit. While preventive, diagnostic, and many comprehensive services are covered, fluoride, implants, orthodontics, maxillofacial prosthetics, and removable prosthodontics are not covered.
Home Infusion bundled Services See details
Humana Gold Plus H6622-054 (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance of 0% to 20%, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Humana Gold Plus H6622-054 (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 H6622-054 (HMO) covers durable medical equipment, prosthetic devices, and medical supplies with a 20% coinsurance and no copayment. Diabetic supplies are covered with a 10% to 20% coinsurance and no copayment, while diabetic therapeutic shoes and inserts require a $10 copayment.
Diagnostic and Radiological Services See details
Humana Gold Plus H6622-054 (HMO) covers diagnostic and radiological services with prior authorization, offering no copay for lab and outpatient X-ray services, and no coinsurance with a $0 to $105 copay for diagnostic tests. Diagnostic radiological services feature copays starting at $0, while therapeutic radiological services require a minimum $30 copay and a minimum 20% coinsurance.
Home Health Services See details
Humana Gold Plus H6622-054 (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus H6622-054 (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus H6622-054 (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by Humana Gold Plus H6622-054 (HMO) include acupuncture for a $30 copay and no coinsurance, limited to 20 treatments per year. Additionally, over-the-counter items and chronic illness meal benefits are covered with no copay and no coinsurance, though prior authorization is required for acupuncture and meals.
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