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Humana Total Complete H2486-003 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Total Complete H2486-003 (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 H2486-003 (HMO) in 2026, please refer to our full plan details page.
Humana Total Complete H2486-003 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Select Counties in UT. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that Humana Total Complete H2486-003 (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 H2486-003 (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 H2486-003 (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 $200.00 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 $5000.00 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 H2486-003 (HMO) prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic drugs cost $5 for a 1-month supply at standard pharmacies, but you can get a 3-month supply with no copay through preferred mail order. For Tier 3 preferred brand drugs, you will pay a $47 copay for a 1-month supply, or $131 for a 3-month supply via preferred mail order. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring a 48% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance. This plan offers a clear structure of copayments and coinsurance to help you manage your healthcare budget.
Additional Benefits
The Humana Total Complete H2486-003 (HMO) plan offers robust medical coverage with affordable cost-sharing, including no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits, members pay a $20 copay, while inpatient hospital stays require a $395 daily copay for the first five days and no copay thereafter. Emergency care is accessible with a $115 copay, which is waived if you are admitted, and urgent care visits require a $50 copay. This plan also features valuable everyday benefits, including routine dental, vision, and hearing exams with no copay. Additionally, members receive up to $200 annually for eyewear and coverage for up to two prescription hearing aids per year with a copay ranging from $699 to $999. Medical equipment and diabetic supplies are covered with no copay and coinsurance ranging from 10% to 20%.
Inpatient Hospital See details
Humana Total Complete H2486-003 (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 to 5 and no copay for days 6 and beyond for acute stays, or days 6 to 90 for psychiatric stays. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Total Complete H2486-003 (HMO) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $395 ($395 per stay for observation services), while individual and group substance abuse sessions have a copay of $0 to $35.
Partial Hospitalization See details
Humana Total Complete H2486-003 (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Total Complete H2486-003 (HMO) covers ground ambulance services with a $335 copay and air ambulance services with a $1,250 copay, both with no coinsurance. Prior authorization is required for ambulance services, and transportation services are not covered.
Emergency Services See details
Emergency services are covered by Humana Total Complete H2486-003 (HMO) with a $115 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 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 Total Complete H2486-003 (HMO) offers primary care physician, mental health, and psychiatric services with no copay and no coinsurance. Specialist visits require a $20 copay, physical, occupational, and speech therapies require a $25 copay, and telehealth services range from a $0 to $50 copay with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
Humana Total Complete H2486-003 (HMO) covers preventive services—including annual physical exams, kidney disease education, glaucoma screenings, and a memory fitness benefit—with no copay and no coinsurance. Additional preventive benefits are only partially covered, as services such as health education, in-home safety assessments, personal emergency response systems, and nutritional therapy are not covered.
Hearing Services See details
Humana Total Complete H2486-003 (HMO) features partially covered hearing services, which include one annual routine exam and unlimited fitting evaluations with no copay and no coinsurance, alongside Medicare-covered exams for a $20 copay and no coinsurance. Up to two prescription hearing aids per year are covered with a copay between $699.00 and $999.00 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Humana Total Complete H2486-003 (HMO) provides partially covered vision services, offering one routine eye exam per year with no copay or coinsurance, though other eye exams are not covered. Eyewear is also partially covered with no copay or coinsurance up to a $200 yearly limit for one pair of contacts or eyeglasses (lenses and frames), while separate eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Total Complete H2486-003 (HMO), offering Medicare-covered dental with a $20 copay and no coinsurance, and other covered dental services with no copay and either no coinsurance or 30% to 40% coinsurance up to a $1,000 annual limit. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Total Complete H2486-003 (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Covered Medicare Part B drugs—including chemotherapy, radiation, insulin, and other drugs—feature coinsurance ranging from no coinsurance up to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the Humana Total Complete H2486-003 (HMO) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Humana Total Complete H2486-003 (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and 15% coinsurance. Diabetic supplies are covered with no copay and 10% to 20% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Total Complete H2486-003 (HMO) with prior authorization required. Diagnostic procedures and tests have a copay ranging from $0 to $50 with no coinsurance, while lab services, outpatient X-rays, and diagnostic radiological services feature no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by Humana Total Complete H2486-003 (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Total Complete H2486-003 (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance under prior authorization, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Total Complete H2486-003 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 46 to 100, a $218 daily copay for days 21 to 45, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Humana Total Complete H2486-003 (HMO) partially covers other services, offering acupuncture with a $20 copay and no coinsurance for up to 20 treatments per year, alongside a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
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