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Humana Total Complete H1036-143 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Total Complete H1036-143 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Humana Total Complete H1036-143 (HMO) in 2026, please refer to our full plan details page.
Humana Total Complete H1036-143 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Emerald Coast. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Humana Total Complete H1036-143 (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 Total Complete H1036-143 (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 Total Complete H1036-143 (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 $1.00. 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 $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 $4300.00 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 Total Complete H1036-143 (HMO) medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic drugs cost as little as a $5 copay for a 1-month supply, with no copay required for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply at standard pharmacies and mail-order services. For higher-tier medications, you will pay a 50% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. These structured copayments and coinsurance rates help you easily estimate your out-of-pocket prescription costs.
Additional Benefits
The Humana Total Complete H1036-143 (HMO) plan offers robust core medical coverage with no deductibles and affordable copayments. Members pay no copay for primary care visits, while specialist visits require a $15 copay and emergency room care has a $130 copay. For inpatient hospital stays, there is a $250 daily copay for the first seven days, followed by no copay for days 8 through 90. This plan also features comprehensive preventive and ancillary benefits, including no copay for routine vision exams, annual physicals, and home health services. Dental care is covered up to a $2,000 annual limit with no copay or coinsurance for preventive services, and routine hearing exams also feature no copay. Additionally, members benefit from a $300 annual eyewear allowance and coverage for over-the-counter items with no copay.
Inpatient Hospital See details
Humana Total Complete H1036-143 (HMO) offers partially covered inpatient hospital services with no coinsurance and a copay of $250 per day for days 1 through 7, followed by no copay for days 8 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Total Complete H1036-143 (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay of $0 to $295, observation services have a $250 copay per stay, and outpatient substance abuse sessions have a $10 to $30 copay, with referral and prior authorization required for most services.
Partial Hospitalization See details
Humana Total Complete H1036-143 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Humana Total Complete H1036-143 (HMO) covers ground ambulance services with a copay of $0 to $240 and air ambulance services with a 20% coinsurance, both requiring prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
Humana Total Complete H1036-143 (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Total Complete H1036-143 (HMO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Therapy services require a $40 copay with no coinsurance, mental health and psychiatric sessions have a $10 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Total Complete H1036-143 (HMO) covers key preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Additional preventive benefits are partially covered, offering fitness benefits, smoking cessation, and in-home support with no copay or coinsurance, while services like health education, nutritional therapy, and home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by Humana Total Complete H1036-143 (HMO) with no coinsurance, featuring a $15 copay for Medicare-covered exams and no copay for routine exams, fitting evaluations, and OTC hearing aids. Prescription hearing aids are partially covered with copays ranging from $199 to $1,299 for up to two aids per year, though inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Total Complete H1036-143 (HMO) provides partially covered vision services with no deductibles and no coinsurance, including one routine eye exam per year with no copay and up to $300 annually for contact lenses and eyeglasses with no copay. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered, and other eye exams may require a copay of up to $15.
Dental Services See details
Dental services are partially covered by Humana Total Complete H1036-143 (HMO) up to a $2,000 annual limit, with no copay and no coinsurance for preventive care and most comprehensive services. Medicare-covered dental services require a $15 copay and no coinsurance, removable prosthodontics require a 30% coinsurance with no copay, and fluoride, endodontics, implants, fixed prosthodontics, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Total Complete H1036-143 (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by Humana Total Complete H1036-143 (HMO) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Humana Total Complete H1036-143 (HMO) covers durable medical equipment (DME) with a 15% coinsurance and no copay. Prosthetics, medical supplies, and diabetic services and supplies are also covered with a 20% coinsurance and no copay, with prior authorization required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Total Complete H1036-143 (HMO), requiring referrals and prior authorization. Lab and diagnostic radiological services have no copay and no coinsurance, diagnostic tests carry a $0 to $225 copay with no coinsurance, outpatient X-rays have no copay but require coinsurance, and therapeutic radiological services have a minimum $10 copay and 20% coinsurance.
Home Health Services See details
Home health services are covered by Humana Total Complete H1036-143 (HMO) with no copay and no coinsurance. Access to these services requires both a referral and prior authorization.
Cardiac Rehabilitation Services See details
Humana Total Complete H1036-143 (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization and referrals are required. While the overall benefit is technically covered, only some services are covered, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Total Complete H1036-143 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 to 20 and a $160 copay for days 21 to 100. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Total Complete H1036-143 (HMO) provides partial coverage for Other Services, offering acupuncture, over-the-counter items, and chronic illness meal benefits with no copay and no coinsurance. Specific sub-services including Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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