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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 2026, 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 2026.
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 $0.00. 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 $615.00 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 $9250.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic drugs, members pay no copay when using standard pharmacies or preferred mail order services. Standard mail order delivery for these generic tiers requires a copay, ranging from $10 to $20 for a 1-month supply up to $30 to $60 for a 3-month supply. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, members pay a consistent 25% coinsurance. This 25% coinsurance applies to standard pharmacies, preferred mail order, and standard mail order options. Understanding these specific copay and coinsurance amounts helps you evaluate the overall value of this Medicare Advantage plan.
Additional Benefits
The Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan provides essential medical coverage, featuring no copay and no coinsurance for preventive care and home health services. For inpatient hospital stays, members pay a copay of $2,230 per acute stay and $2,080 per psychiatric stay with no coinsurance. Primary care, specialist visits, and many diagnostic services feature no copay and a 20% coinsurance. This plan also includes valuable supplemental benefits, such as dental care up to a $5,000 annual limit with no copay and 20% coinsurance for Medicare-covered services. Routine vision and hearing benefits are highly accessible, offering no copay and a 20% coinsurance for exams, alongside no copay or coinsurance for select hearing aids and up to $350 annually for eyewear. Additionally, members can access up to 24 one-way routine transportation trips and over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and while unlimited additional acute days are covered at no copay, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) plan, with ambulatory surgical center services requiring no copay and no coinsurance. Outpatient hospital services carry a copay of $0 to $250 and 20% coinsurance, while outpatient substance abuse and blood services feature no copay and 20% coinsurance.
Partial Hospitalization See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers ground and air ambulance services with a $335 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and a 20% coinsurance. Chiropractic care is partially covered with no copay and 20% coinsurance for up to 12 routine visits annually, though other chiropractic services are not covered, and telehealth services carry a $0 to $40 copay with 20% coinsurance.
Preventive Services See details
Preventive services are covered by Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. However, additional preventive benefits are only partially covered, excluding services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
Hearing services are covered by Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) with no deductible, featuring routine hearing exams for a 20% coinsurance and no copay, and unlimited fitting evaluations with no copay. Prescription hearing aids are partially covered with no copay or coinsurance for up to two aids every three years (excluding inner ear, outer ear, and over the ear types), while over-the-counter hearing aids are covered with no copay or coinsurance.
Vision Services See details
Vision services are partially covered by Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP), offering one routine eye exam per year with no copay and 20% coinsurance, plus up to $350 annually for contact lenses or eyeglasses with no copay, no coinsurance, and no deductible. Other eye exams, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) features partially covered dental services with a $5,000 annual limit, requiring no copay and a 20% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers home infusion bundled services with prior authorization, requiring a $35 copay and 0% to 20% coinsurance for Part B insulin. Medicare Part B chemotherapy and radiation drugs require 0% to 20% coinsurance, while other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment with no copay and a 20% coinsurance. Prior authorization is required for these benefits, and diabetic supplies are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers diagnostic and radiological services subject to a 20% coinsurance and prior authorization. Lab and radiological services feature no copay, while outpatient X-rays carry a $40 copay, and diagnostic procedures and tests require a copay ranging from no copay up to $40.
Home Health Services See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers some cardiac rehabilitation services with no copay and a 20% coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 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 SNP-DE H6622-078 (HMO D-SNP) covers acupuncture with no copay and 20% coinsurance for up to 20 yearly treatments, alongside chronic illness meal benefits and over-the-counter (OTC) items with no copay and no coinsurance. While nicotine replacement therapy and naloxone are covered, some items on the CMS OTC list are not covered under this plan.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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