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Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in 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 SNP-DE H6622-078 (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP).
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 SNP-DE H6622-078 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.70. 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 $590.00 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 $9350.00 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 SNP-DE H6622-078 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the cost-sharing amounts for your drugs based on the drug tier. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). With LIS, you'll pay $23.70 per month for Part D. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan offers a wide range of benefits. This plan includes coverage for inpatient hospital stays with a copay, and outpatient services with varying copays and coinsurance. Emergency, primary care, and preventive services are covered, with some services having no copay. Additional benefits include coverage for hearing, vision, and dental services, with specific copays and coinsurance. The plan also covers medical equipment, diagnostic services, home health, skilled nursing, and other services like acupuncture, meal benefits, and over-the-counter items. However, some services may require prior authorization, and there are limitations on coverage for certain services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, the copay is $2185.00 per admission or stay, and for Inpatient Hospital Psychiatric, the copay is $2036.00 per admission or stay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $250 copay and 20% coinsurance, Observation Services with a $500 copay, Ambulatory Surgical Center (ASC) Services with a $200 copay and 20% coinsurance, Outpatient Substance Abuse Services with 20% coinsurance for individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $315 copay. Transportation Services to plan-approved health-related locations are covered with no copay, up to 12 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. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and all services have no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with a 19% coinsurance. Chiropractic Services are covered with a 20% coinsurance, and Routine Chiropractic Care has no copay. Occupational Therapy Services are covered with a 20% coinsurance. Physician Specialist Services are covered with a 20% coinsurance. Mental Health Specialty Services are covered with a 20% coinsurance for individual and group sessions. Podiatry Services are covered with a 20% coinsurance for routine foot care, and Medicare-covered podiatry services have no copay. Other Health Care Professional Services are covered with a coinsurance between 19% and 20%. Psychiatric Services are covered with a 20% coinsurance for individual and group sessions. Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance. Additional Telehealth Benefits are covered with a 20% coinsurance and a copay between $0 and $45. Opioid Treatment Program Services are covered with a 20% coinsurance.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams with no copay, and additional services like wigs for hair loss, smoking cessation counseling, and fitness benefits, all with no copay. Other services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing exams are covered, with a coinsurance of at most 20% for routine hearing exams, and no copay for Medicare-covered benefits and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, as well as eyewear. Eyewear includes contact lenses and eyeglasses (lenses and frames) with no copay, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including Medicare dental services with 20% coinsurance and other dental services up to a $5,000 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, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay and a limited number of visits. Fluoride treatment, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 19%. For Medicare Part B Chemotherapy/Radiation Drugs, there is a coinsurance between 0% and 20%. For Other Medicare Part B Drugs, there is no copay and a coinsurance between 0% and 19%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment with an 18% coinsurance and no copay, and Prosthetics/Medical Supplies with no copay, and Diabetic Equipment with a coinsurance and copay, and Diabetic Supplies with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay of up to $45 and a coinsurance of at most 20%, while Lab Services have no copay and a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of up to $325 and a coinsurance of at most 20%, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $45 copay and a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered 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 SNP-DE H6622-078 (HMO D-SNP) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP). There is no 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 SNP-DE H6622-078 (HMO D-SNP) plan covers acupuncture with 20% coinsurance, and a meal benefit with no copay. Over-the-counter items are covered with a maximum plan benefit coverage amount of $1500.00 per year. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and several other services are not covered.
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