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Humana Gold Plus SNP-DE H6622-087 (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 H6622-087 (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 H6622-087 (HMO D-SNP) in 2025, please refer to our full plan details page.
Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP) is a HMO D-SNP plan offered by Humana Inc. available for enrollment in 2025 to people living in Select counties in Ohio. 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 H6622-087 (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 H6622-087 (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 H6622-087 (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 H6622-087 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.70. 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 H6622-087 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet the deductible, you pay the costs for your drugs, but the specific costs for each drug tier are not available in this summary. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your premium will be $36.70.
Additional Benefits
The Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a high copay, while outpatient services and primary care often have a 20% coinsurance. Emergency services have a copay, and ambulance services have a copay, but transportation to health-related locations has no copay for up to 100 one-way trips per year. This plan provides several services with no copay, including preventive services, hearing and vision exams, and dental cleanings. Home health services also have no copay. Additionally, the plan covers prescription hearing aids, and offers a meal benefit, and an over-the-counter benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but the copay is $2185 per admission or stay for Inpatient Hospital-Acute and $2036 per admission or stay for Inpatient Hospital Psychiatric. Additional Days for Inpatient Hospital-Acute are covered with no copay, while 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.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and ambulatory surgical center (ASC) services, are covered with a 20% coinsurance. Outpatient substance abuse services, including individual and group sessions, are covered with a 20% coinsurance. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, 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, and transportation services to a plan-approved health-related location with no copay for up to 100 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 under the Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a 20% coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have a $110 copay.
Primary Care See details
The Humana Gold Plus SNP-DE H6622-087 (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, Speech-Language Pathology Services and Additional Telehealth Benefits have a 20% coinsurance. Chiropractic Services and Podiatry Services have a 20% coinsurance, and Routine Chiropractic Care has no copay. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a 20% coinsurance. Occupational Therapy Services has a 20% coinsurance and no copay. Additional Telehealth Benefits have no copay.
Preventive Services See details
Preventive services include an annual physical exam with no copay, additional preventive services with a copay, and wigs for hair loss related to chemotherapy, also with no copay. Other services like health education, and in-home safety assessments are not covered.
Hearing Services See details
The Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP) plan covers hearing exams with at most 20% coinsurance for routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with no copay for all types, 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 H6622-087 (HMO D-SNP) plan covers vision services including eye exams with no copay and 20% coinsurance, and eyewear. Eyewear coverage includes contact lenses with no copay and 20% coinsurance, 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. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and other preventive dental services are covered with no copay. 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, including Medicare Part B Chemotherapy/Radiation Drugs, Other Medicare Part B Drugs, and Medicare Part B Insulin Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay. For all other drugs, there is a coinsurance between 0% and 20%, and there is no copay for Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus SNP-DE H6622-087 (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 20% coinsurance, and Diabetic Equipment, with no copay for diabetic supplies and diabetic therapeutic shoes/inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a coinsurance of at most 20%, and Lab Services have a 20% coinsurance and no copay. Diagnostic Radiological Services have a coinsurance of at most 20% and a copay of at most $325, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a coinsurance of at most 20% and no copay.
Home Health Services See details
Home Health Services are covered by the Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP) plan 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 H6622-087 (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Humana Gold Plus SNP-DE H6622-087 (HMO D-SNP) plan, with a $0 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 H6622-087 (HMO D-SNP) plan covers acupuncture with 20% coinsurance, and a meal benefit with no copay. Over-the-counter items are also covered, with a maximum plan benefit coverage amount of $2700.
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