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Humana Gold Plus H6622-081 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus H6622-081 (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 H6622-081 (HMO) in 2025, please refer to our full plan details page.
Humana Gold Plus H6622-081 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Greater Baltimore. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Humana Gold Plus H6622-081 (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 H6622-081 (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 H6622-081 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.00. 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 $300.00 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 $8550.00 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 H6622-081 (HMO) plan has a $300 deductible for prescription drugs. Once you meet your deductible, your cost sharing will vary depending on the drug tier and pharmacy. For preferred generic drugs, you will pay a $5 copay at preferred pharmacies and through the preferred mail order service, and a $20 copay at standard pharmacies. For standard generic drugs, the copay is $47. For preferred brand drugs, the coinsurance is 35%, and for non-preferred drugs, the coinsurance is 29%. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase where you will pay nothing for your covered drugs.
Additional Benefits
The Humana Gold Plus H6622-081 (HMO) plan offers comprehensive coverage with a focus on outpatient services, including a range of copays from $0 to $775 depending on the service. Inpatient hospital stays have a copay of $270 per day for days 1-8, with no copay for days 9-90. The plan also includes no copay for primary care, preventive services, and many additional services, such as routine hearing exams. The plan covers a variety of services with varying costs, including a $40 copay for mental health services, and a $40 copay for hearing exams. Vision services include eye exams with no copay and eyewear with no copay up to a $100 annual maximum. Dental services include no copay for Medicare dental services, and a coinsurance for restorative services.
Inpatient Hospital See details
Inpatient hospital services are covered, with a copay of $270 per day for days 1-8, and no copay for days 9-90. Inpatient hospital psychiatric services are also covered with a copay of $275 for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered with a copay of $40-$775, depending on the service. Observation Services have a $270 copay, and Ambulatory Surgical Center (ASC) Services have a $285 copay. Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $40-$90. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Humana Gold Plus H6622-081 (HMO) plan, but requires prior authorization. The copay for this benefit is $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $315 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a copay. For Emergency Services and Worldwide Emergency Coverage, the copay is $110, while Urgently Needed Services has a $45 copay. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $110 copay. There is no coinsurance for any of these services.
Primary Care See details
The Humana Gold Plus H6622-081 (HMO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $10-$35 copay, and physician specialist services with a $40 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $40 copay for individual and group sessions, and physical therapy and speech-language pathology services have a $10-$35 copay. The plan also covers additional telehealth benefits with a $0-$45 copay, and routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, with no copay, and an annual physical exam with no copay. Additional preventive services, including Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, are covered with no copay. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
The Humana Gold Plus H6622-081 (HMO) plan covers hearing exams with a $40 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $699 and $999, while inner ear, outer ear, and over the ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
The Humana Gold Plus H6622-081 (HMO) plan covers vision services, including eye exams with a copay of $0-$40 and eyewear with a $0 copay and a combined maximum benefit of $100 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Humana Gold Plus H6622-081 (HMO) plan covers a range of dental services. Medicare Dental Services have a $40 copay, while other services like oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. Restorative services and prosthodontics have a 30% - 40% coinsurance with no copay, while fluoride treatment, prosthodontics, removable, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B insulin drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus H6622-081 (HMO) plan. The coinsurance for this service is 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered under the Humana Gold Plus H6622-081 (HMO) plan. Durable Medical Equipment for use outside the home is not covered, while Prosthetic Devices and Medical Supplies have a 4% coinsurance; Diabetic Supplies have a 10% coinsurance and no copay, and Diabetic Therapeutic Shoes/Inserts have an $8 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Humana Gold Plus H6622-081 (HMO) plan. Diagnostic Procedures/Tests have a copay of $0-$95, Lab Services have no copay, Diagnostic Radiological Services have a copay of $40-$325, Therapeutic Radiological Services have a copay of $40 and a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus H6622-081 (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 H6622-081 (HMO) plan. Although the plan generally covers this benefit, 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, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Humana Gold Plus H6622-081 (HMO) plan covers acupuncture with a $40 copay, limited to 20 treatments per year, and meal benefits with no copay. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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