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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 2025, 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 2025.
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 $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 $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 has a $300 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, standard generic drugs have a $5 copay at a standard pharmacy, while preferred brand drugs have a 43% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, those who qualify for the low-income subsidy (LIS) will have their premiums reduced.
Additional Benefits
The Humana Gold Plus H6622-054 (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $290 copay for the first seven days, with no copay for the remainder, and outpatient services have copays ranging from $0 to $660. This plan also includes coverage for services like primary care with no copay, hearing services with a copay, vision services with no copay, and dental services with a $30 copay for Medicare dental services. Additional benefits include coverage for ambulance services, emergency services, and diagnostic services. This plan also covers home health services with no copay, along with partial hospitalization, skilled nursing facilities, and cardiac rehabilitation. The plan offers other services like acupuncture, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include acute and psychiatric care, with a copay of $290 per day for days 1-7 for acute and psychiatric care, and no copay for days 8-90 for acute care and days 7-90 for psychiatric care. Additional days for acute inpatient hospital care are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $660, observation services with a $290 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a copay between $30 and $80 for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by Humana Gold Plus H6622-054 (HMO), with a $55 copay. Prior authorization is required 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, and transportation services to a plan-approved health-related location have no copay for up to 24 one-way trips per year. 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 under the Humana Gold Plus H6622-054 (HMO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay.
Primary Care See details
The Humana Gold Plus H6622-054 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, and occupational therapy services with a copay between $20-$30. The plan also covers physician specialist services with a $30 copay, mental health specialty services with a $30 copay for individual or group sessions, and physical therapy and speech-language pathology services with a copay between $20-$30. Additionally, this plan covers additional telehealth benefits with a copay between $0-$45, and opioid treatment program services with a copay between $30-$80. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services, with some services like health education and in-home safety assessments not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $30 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 $699 and $999 for all types, while OTC hearing aids are covered up to $15 per month.
Vision Services See details
The Humana Gold Plus H6622-054 (HMO) plan covers eye exams with a copay of $0-$30. Eyewear is covered with no copay, and a combined maximum benefit of $100 per year.
Dental Services See details
The Humana Gold Plus H6622-054 (HMO) plan covers dental services, including Medicare dental services with a $30 copay, and other dental services with a $3,000 maximum. 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 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, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs also have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H6622-054 (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered by the Humana Gold Plus H6622-054 (HMO) plan. Durable Medical Equipment (DME) has a 15% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies are covered, with a 16% coinsurance for Medicare-covered services, and Diabetic Equipment is covered, with 10% coinsurance and no copay for Diabetic Supplies, and a $10 copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay between $0 and $105 for diagnostic procedures, and no copay for lab services. Outpatient X-ray services have no copay, while diagnostic radiological services have a copay up to $300, and therapeutic radiological services have a copay up to $30 and a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H6622-054 (HMO) 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 covered, but not the sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H6622-054 (HMO) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Humana Gold Plus H6622-054 (HMO) plan covers acupuncture with a $30 copay and a limit of 20 treatments per year, and also covers Over-the-Counter (OTC) items with a monthly benefit of $15, and also 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, and Self-Directed Personal Assistance Services.
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