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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 2026, 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 and N. KY. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus H6622-055 (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 $16.00. 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 $6550.00 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) prescription drug plan features an annual drug deductible of $200. Under this plan, Tier 1 preferred generic drugs are highly affordable, offering no copay for a one-month or three-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also cost-effective, costing as little as a $10 copay for a one-month supply at standard pharmacies, or no copay for a three-month supply via preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a one-month supply, with savings available on three-month supplies through preferred mail order. Tier 4 non-preferred drugs require a 50% coinsurance across all pharmacy options, while Tier 5 specialty drugs incur a 30% coinsurance for a one-month supply. This structure helps beneficiaries manage their medication expenses by choosing preferred pharmacies and mail-order services.
Additional Benefits
The Humana Gold Plus H6622-055 (HMO) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive services, and home health care. For specialized care, members pay a $45 copay for specialist visits, while inpatient acute hospital stays require a $460 daily copay for the first five days with no copay thereafter. Emergency room services carry a $130 copay, which is waived if admitted within 24 hours, and urgent care is available for a $50 copay. This plan also includes key supplemental benefits, offering no copay for routine dental, vision, and hearing exams. Dental coverage is capped at a $1,000 annual limit, while vision benefits provide up to $300 annually for eyewear with no copay. For medical supplies and dialysis, members can expect no copay and a 20% coinsurance.
Inpatient Hospital See details
Humana Gold Plus H6622-055 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. Acute stays require a $460 daily copay for days 1-5 and no copay for days 6 and beyond, while psychiatric stays require a $460 daily copay for days 1-4 and no copay for days 5-90. Non-Medicare-covered stays, room upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus H6622-055 (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $35 copay for outpatient substance abuse sessions. Outpatient hospital services carry a copay ranging from $0 to $460, while outpatient observation services require a $460 copay per stay, both with no coinsurance.
Partial Hospitalization See details
Humana Gold Plus H6622-055 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Humana Gold Plus H6622-055 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered.
Emergency Services See details
Humana Gold Plus H6622-055 (HMO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $50 copay, with no coinsurance for either. Worldwide emergency, urgent, and transportation services are also covered under the plan with a $130 copay and no coinsurance.
Primary Care See details
Humana Gold Plus H6622-055 (HMO) covers primary care visits with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Other services like physical therapy, mental health, and telehealth feature copays ranging from $0 to $50 with no coinsurance, while chiropractic care has some services covered but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Gold Plus H6622-055 (HMO) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and a memory fitness benefit. Non-covered services include health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Humana Gold Plus H6622-055 (HMO) hearing services are partially covered, offering Medicare-covered exams for a $45 copay and no coinsurance, and routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered up to two per year with a copay between $699 and $999 and no coinsurance, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus H6622-055 (HMO) with no deductibles or coinsurance, offering no copay for one routine eye exam per year and one pair of contact lenses or eyeglasses up to a $300 annual limit. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus H6622-055 (HMO) partially covers dental services up to a $1,000 annual limit, offering most preventive and diagnostic services with no copay and no coinsurance, restorative services with a $25 copay and no coinsurance, and Medicare-covered dental with a $45 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Humana Gold Plus H6622-055 (HMO) with no copay, though prior authorization is required. Related Medicare Part B drugs, including chemotherapy, radiation, and insulin, require a coinsurance ranging from no coinsurance to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus H6622-055 (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Gold Plus H6622-055 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay and a 10% to 20% coinsurance, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Gold Plus H6622-055 (HMO) covers diagnostic and radiological services with prior authorization, offering no copay for lab services and outpatient X-rays. Diagnostic procedures and tests range from a $0 to $105 copay with no coinsurance, diagnostic radiological services start at no copay, and therapeutic radiological services require a minimum 20% coinsurance and a $35 copay.
Home Health Services See details
Home Health Services are covered by Humana Gold Plus H6622-055 (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Humana Gold Plus H6622-055 (HMO) plan, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered in practice.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus H6622-055 (HMO) partially covers skilled nursing facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Gold Plus H6622-055 (HMO) offers partial coverage for other services, including acupuncture for a $45 copay and no coinsurance for up to 20 treatments per year, and chronic illness meal benefits with no copay and no coinsurance. Both of these covered services require prior authorization, while over-the-counter (OTC) items are not covered.
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