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Humana Gold Plus SNP-DE H6622-086 (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 H6622-086 (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 H6622-086 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H6622-086 (HMO D-SNP) is a HMO D-SNP 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 SNP-DE H6622-086 (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 H6622-086 (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 H6622-086 (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 H6622-086 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.20. 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 H6622-086 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D drugs will be $26.20.
Additional Benefits
The Humana Gold Plus SNP-DE H6622-086 (HMO D-SNP) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays and coinsurance. Emergency, primary care, preventive, hearing, vision, and dental services are also included with specific copays, coinsurance, and annual maximums. Additional benefits include ambulance and transportation services, home health services, medical equipment, and other services like acupuncture and an over-the-counter allowance. This plan provides coverage for a wide range of services, including inpatient and outpatient care, with specific copays for certain services such as inpatient hospital stays and emergency services. You will also find coverage for services like home health, hearing, vision, and dental, with a focus on preventive care through no-copay annual physical exams, and an over-the-counter allowance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute, there is a $1730 copay per admission or stay, and for Inpatient Hospital Psychiatric, there is a $1700 copay per admission or stay.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $250 copay and 20% coinsurance, observation services with a $500 copay, ambulatory surgical center 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 have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground and air ambulance services have a $315 copay, while transportation services to a plan-approved health-related location have no copay, with 48 one-way trips covered per year using a taxi, bus/subway, or medical transport. 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 this plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services have a $45 copay; all services have no coinsurance.
Primary Care See details
The Humana Gold Plus SNP-DE H6622-086 (HMO D-SNP) plan covers 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. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have a 20% coinsurance, while Routine Chiropractic Care has no copay and Routine Foot Care has no copay, and Additional Telehealth Benefits has a copay between $0 and $45.
Preventive Services See details
Preventive Services include coverage for an annual physical exam with no copay. Additional preventive services, including wigs for hair loss related to chemotherapy, additional sessions of smoking and tobacco cessation counseling, and fitness benefits, are also covered. 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 a copay for Medicare-covered benefits and fitting/evaluation for hearing aids, and prescription hearing aids. Fitting/evaluation for hearing aids has no copay. Prescription hearing aids are covered for all types, with no copay, and routine hearing exams have no copay. However, inner ear, outer ear, and over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
The Humana Gold Plus SNP-DE H6622-086 (HMO D-SNP) plan covers vision services, including eye exams with no copay and 20% coinsurance, and eyewear with a 20% coinsurance. Eyewear coverage includes contact lenses and eyeglasses (lenses and frames), with a combined maximum benefit of $350 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $1,000 maximum benefit per year. Medicare dental services have a 20% coinsurance, while oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services have no copay. Fluoride treatment, endodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), oral and maxillofacial surgery, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. With Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance. For both Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is no copay, and the coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Humana Gold Plus SNP-DE H6622-086 (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 19% coinsurance, Prosthetics/Medical Supplies with a 19% coinsurance, and Diabetic Equipment with a 20% coinsurance for Diabetic Supplies, and no copay for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The Humana Gold Plus SNP-DE H6622-086 (HMO D-SNP) plan covers diagnostic and radiological services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray 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%, and therapeutic radiological services and outpatient X-ray services have a coinsurance of at most 20%, with outpatient X-ray services also having a $45 copay.
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 covered, but not in practice, as none of the sub-services are covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Humana Gold Plus SNP-DE H6622-086 (HMO D-SNP) plan. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Humana Gold Plus SNP-DE H6622-086 (HMO D-SNP) plan covers acupuncture with a 20% coinsurance, up to 20 treatments per year, and also covers over-the-counter (OTC) items, with a maximum benefit of $1,200 per year. The plan also covers a meal benefit with no copay. However, other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and Private Duty Nursing Services are not covered.
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