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Humana Gold Plus H6622-055 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-055 (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 H6622-055 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H6622-055 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Ohio. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H6622-055 (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 H6622-055 (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 H6622-055 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $200.00 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 $6750.00 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 H6622-055 (HMO) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, in the initial coverage phase, you will pay $10 for preferred generic drugs at preferred mail pharmacies. For preferred brand drugs, you will pay 48% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Humana Gold Plus H6622-055 (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services with varying copays. Emergency services and primary care visits have copays, and there is also coverage for vision and dental services, with specific copays and annual maximums. This plan provides additional coverage for services like home health, skilled nursing facilities, and ambulance services, each with its own cost structure. There is also coverage for hearing exams and medical equipment, and coverage for services like acupuncture and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $460 copay for days 1-5, and no copay for days 6-90, while additional days have no copay. For Inpatient Hospital Psychiatric, you pay a $460 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $460, and observation services with a $460 copay. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay, and Outpatient Substance Abuse Services have copays between $45 and $100 for individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Humana Gold Plus H6622-055 (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance Services are covered by the Humana Gold Plus H6622-055 (HMO) plan, with a $315 copay for both ground and air ambulance services, and no coinsurance. Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Humana Gold Plus H6622-055 (HMO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Humana Gold Plus H6622-055 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a copay between $10 and $40, and physician specialist services with a $45 copay. Mental health specialty services, podiatry services, psychiatric services, and opioid treatment program services have a copay of $45, and other health care professional services have a copay between $0 and $45. Physical therapy and speech-language pathology services have a copay between $10 and $40, and additional telehealth benefits have a copay between $0 and $55.
Preventive Services See details
Preventive Services include Medicare-covered services, Annual Physical Exams, Kidney Disease Education Services, and Other Preventive Services. Annual Physical Exams have no copay, while the other services have varying copays. Additional services like Health Education, In-Home Safety Assessment, and others are not covered.
Hearing Services See details
Hearing Services are partially covered by the Humana Gold Plus H6622-055 (HMO) plan. Hearing exams have a $45 copay, but routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids (all types, inner ear, outer ear, and over the ear), and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus H6622-055 (HMO) plan covers vision services, including eye exams with a copay between $0 and $45, and eyewear with no copay. Contact lenses and eyeglasses (lenses and frames) are covered with no copay, up to a combined maximum of $300 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $45 copay, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Other Preventive Dental Services, and Restorative Services with a $25 copay. Fluoride Treatment, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered. There is a $1,000 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Humana Gold Plus H6622-055 (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus H6622-055 (HMO) plan, but prior authorization is required. The coinsurance for these services is between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered by this plan. Durable medical equipment has a 20% coinsurance, while prosthetics and medical supplies have a 20% coinsurance, and diabetic supplies have a coinsurance between 10% and 20%, and diabetic therapeutic shoes/inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by this plan. Diagnostic Procedures/Tests have a copay between $0 and $105, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $720, and Therapeutic Radiological Services have a copay of at most $35 and a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H6622-055 (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 H6622-055 (HMO) plan. Prior authorization is required for this benefit, but the plan does not cover any of the specific sub-services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus H6622-055 (HMO) plan, with a $10 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H6622-055 (HMO) plan covers acupuncture with a $45 copay and a limit of 20 treatments per year, and also covers a meal benefit with no copay. Other services like over-the-counter items, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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