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Humana Gold Plus Giveback H6622-090 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Gold Plus Giveback H6622-090 (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 Giveback H6622-090 (HMO) in 2026, please refer to our full plan details page.
Humana Gold Plus Giveback H6622-090 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Tidewater. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that Humana Gold Plus Giveback H6622-090 (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 Giveback H6622-090 (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 Giveback H6622-090 (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $129.00. You must continue to pay paying your reduced 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 $450.00 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 Giveback H6622-090 (HMO) prescription drug plan features an annual drug deductible of $450. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, members enjoy no copay for both 1-month and 3-month supplies at standard pharmacies and through preferred mail order. If utilizing standard mail order, Tier 1 drugs require a $10 copay for a 1-month supply ($30 for 3-month), while Tier 2 drugs carry a $20 copay ($60 for 3-month). Tier 3 (Preferred Brand) drugs have a $47 copay for a 1-month supply, with 3-month options costing $141 at standard pharmacies and standard mail, or a discounted $131 through preferred mail order. Tier 4 (Non-Preferred) medications require a 44% coinsurance across all standard pharmacy and mail order channels. Specialty drugs in Tier 5 incur a 27% coinsurance for a 1-month supply through standard pharmacies and mail order.
Additional Benefits
The Humana Gold Plus Giveback H6622-090 (HMO) plan offers affordable coverage for your essential medical needs, featuring no copay for primary care visits, preventive services, and routine dental and vision exams. For specialized care, you will pay a $40 copay for specialists and a $25 copay for physical, occupational, and speech therapy, with no coinsurance required for these services. Inpatient hospital stays require a $375 daily copay for the first few days, while outpatient hospital services range from no copay up to a $450 copay. Emergency care is accessible with a $115 copay, and urgently needed services require a $40 copay, both with no coinsurance. Additionally, diagnostic lab tests, home health care, and cardiac rehabilitation are covered with no copay and no coinsurance, while durable medical equipment and dialysis services require a 20% coinsurance. Routine hearing exams also have no copay, and prescription hearing aids are covered with copays ranging from $699 to $999.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Humana Gold Plus Giveback H6622-090 (HMO) with no coinsurance, requiring a $375 daily copay for days 1 to 7 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Gold Plus Giveback H6622-090 (HMO) covers outpatient hospital services with a $0 to $450 copay and observation services with a $375 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by the Humana Gold Plus Giveback H6622-090 (HMO) plan with a $35.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Humana Gold Plus Giveback H6622-090 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance, though prior authorization is required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by Humana Gold Plus Giveback H6622-090 (HMO) with a $115 copay and no coinsurance, which is 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 Giveback H6622-090 (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Physical, occupational, and speech therapy are covered with a $25 copay and no coinsurance, and mental health services have a $35 copay and no coinsurance. Podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
Humana Gold Plus Giveback H6622-090 (HMO) partially covers preventive services, offering annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. Additional services—including fitness benefits, health education, in-home safety assessments, PERS, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, safety devices, and counseling—are not covered.
Hearing Services See details
Hearing services are partially covered by Humana Gold Plus Giveback H6622-090 (HMO) with no deductible and no coinsurance. Routine exams and fitting evaluations have no copay, Medicare-covered exams require a $40 copay, and up to two annual prescription hearing aids have a copay of $699 to $999. OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by Humana Gold Plus Giveback H6622-090 (HMO) with no deductibles, no coinsurance, and no copay for routine eye exams and select eyewear, subject to a $150 annual limit and prior authorization. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Gold Plus Giveback H6622-090 (HMO) dental services are partially covered, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive and 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 Giveback H6622-090 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry no coinsurance to 20% coinsurance, with insulin also subject to a $35 copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Gold Plus Giveback H6622-090 (HMO) plan with no copay and a 20% coinsurance, with prior authorization required.
Medical Equipment See details
Humana Gold Plus Giveback H6622-090 (HMO) covers durable medical equipment and prosthetics with a 20% coinsurance and no copay. Diabetic supplies are covered with 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Gold Plus Giveback H6622-090 (HMO), with prior authorization required. Diagnostic services feature no coinsurance, offering lab services with no copay and other tests with a copay between $0 and $120. Radiological services feature no copay for X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance alongside a $40 copay for therapeutic radiology.
Home Health Services See details
Humana Gold Plus Giveback H6622-090 (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by Humana Gold Plus Giveback H6622-090 (HMO) with no copay and no coinsurance, but prior authorization is required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Humana Gold Plus Giveback H6622-090 (HMO) with no coinsurance, offering 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 100 days are not covered.
Other Services See details
Other services are partially covered by Humana Gold Plus Giveback H6622-090 (HMO), featuring acupuncture with a $40 copay and no coinsurance for up to 20 yearly treatments, and a meal benefit with no copay and no coinsurance for qualifying conditions. Over-the-counter (OTC) items are not covered, and prior authorization is required for the covered services.
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