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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. Once you meet your deductible, you will pay the costs for your prescriptions based on the drug tier. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). If you qualify, you will pay $23.70 for Part D. After your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for covered drugs.
Additional Benefits
The Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays and coinsurance. You'll have no copay for preventive services like annual physical exams, and many other services, such as home health and dental services. The plan also includes coverage for ambulance and transportation, emergency services, and various primary care services, such as primary care physician services and chiropractic services. Additionally, it provides coverage for hearing, vision, and dental services, and offers additional benefits like home infusion, dialysis, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization, and the copay for a Medicare-covered stay is $2185.00 and $2036.00, respectively. Additional Days for Inpatient Hospital-Acute is covered, and Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
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, but requires prior authorization. You will pay a 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan. Ground and air ambulance services have a $315 copay, and transportation services to a plan-approved health-related location are covered with no copay for up to 12 one-way trips per year, but 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 SNP-DE H6622-078 (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, and Urgently Needed Services have a $45 copay; all services have no coinsurance.
Primary Care See details
Primary Care, including Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, and Additional Telehealth Benefits have a copay between $0 and $45. Chiropractic Services and Podiatry Services have a 20% coinsurance, and Routine Chiropractic Care has no copay, while Medicare-covered Podiatry Services have no copay. Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Occupational Therapy Services has a 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for annual physical exams with no copay, and additional preventive services may have a copay. Additional services such as health education, in-home safety assessments, and others are not covered. Other services like glaucoma screening, diabetes self-management training, and others have no copay.
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 prescription 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, and eyewear with no copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services, and other dental services have 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, but fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B drugs with no copay. Coinsurance applies to all Home Infusion bundled Services, ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan, and require prior authorization. You will be responsible for a 20% coinsurance.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), prosthetics, medical supplies, and diabetic equipment are covered. DME has a 20% coinsurance and no copay, while medical supplies and prosthetic devices have a 20% coinsurance and no copay. For diabetic supplies, there is a 20% coinsurance and no copay, while diabetic therapeutic shoes/inserts have no copay.
Diagnostic and Radiological Services See details
The Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay of up to $45 and coinsurance of up to 20%, lab services with no copay and coinsurance of up to 20%, diagnostic radiological services with a copay of up to $325 and coinsurance of up to 20%, therapeutic radiological services with coinsurance of up to 20%, and outpatient X-ray services with a $45 copay and coinsurance of up to 20%. All services require prior authorization.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. However, 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. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
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) plan, but require prior authorization. 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 are not covered.
Other Services See details
The Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan covers acupuncture with a 20% coinsurance and a limit of 20 treatments per year, and also covers Over-the-Counter (OTC) items up to $1200 per year. The plan also offers a meal benefit with no copay, and covers meals for chronic illnesses. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered.
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