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Humana Total Complete H4461-043 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Total Complete H4461-043 (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 H4461-043 (HMO) in 2026, please refer to our full plan details page.
Humana Total Complete H4461-043 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2025 to people living in Nashville. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Total Complete H4461-043 (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 H4461-043 (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 H4461-043 (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 $5100.00 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 H4461-043 (HMO) plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for 1-month or 3-month supplies 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. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply, with a slightly discounted $131 copay for a 3-month supply via preferred mail order. For higher-tier medications, you will pay a 41% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. These clear tier costs help you easily budget for your monthly and yearly prescription medication needs.
Additional Benefits
The Humana Total Complete H4461-043 (HMO) plan offers affordable medical coverage with no copay for primary care visits and a low $15 copay for specialists. For inpatient hospital stays, members pay a $285 daily copay for the first six days and no copay for days 7 through 90. Emergency room visits carry a $115 copay, which is waived upon admission, while outpatient hospital visits feature a copay ranging from no copay to $250. Supplemental coverage includes comprehensive dental services with no copay for most preventive and restorative care up to a $3,000 annual limit. Routine vision and hearing exams feature no copay, with additional coverage for eyewear up to $400 and prescription hearing aids requiring a $399 to $699 copay. Skilled nursing care is available with no copay for the first 20 days, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Humana Total Complete H4461-043 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $285 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days beyond 90 days are not covered.
Outpatient Services See details
Humana Total Complete H4461-043 (HMO) covers outpatient services with no coinsurance, featuring a $0 to $250 copay for outpatient hospital visits and a $285 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay or coinsurance, while outpatient substance abuse sessions have a $35 copay with no coinsurance.
Partial Hospitalization See details
Humana Total Complete H4461-043 (HMO) covers partial hospitalization services with a $35 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Humana Total Complete H4461-043 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to plan-approved or any health-related locations are not covered by this plan.
Emergency Services See details
Humana Total Complete H4461-043 (HMO) covers emergency services 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 Total Complete H4461-043 (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Physical therapy costs a $20 copay and no coinsurance, and mental health sessions require a $35 copay and no coinsurance, though podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are covered by Humana Total Complete H4461-043 (HMO) with no copay and no coinsurance for annual exams, kidney disease education, and select screenings. However, the benefit is only partially covered, as it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, home safety modifications, and counseling.
Hearing Services See details
Humana Total Complete H4461-043 (HMO) covers Medicare-covered hearing exams for a $15 copay, while routine exams and fitting evaluations have no copay, both with no coinsurance. Prescription hearing aids are partially covered with a $399 to $699 copay 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 H4461-043 (HMO) partially covers vision services with no deductible and no coinsurance, offering eye exams with a copay ranging from no copay to $15 and eyewear with no copay up to a $400 annual limit. Covered benefits include routine eye exams, contact lenses, and eyeglasses, while other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Total Complete H4461-043 (HMO) dental services are partially covered, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $3,000 annual limit. Most preventive, diagnostic, and restorative services are covered with no copay and no coinsurance, but fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Total Complete H4461-043 (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, insulin, and other drugs are covered with no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Humana Total Complete H4461-043 (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Total Complete H4461-043 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Humana Total Complete H4461-043 (HMO) with prior authorization required. Diagnostic labs and outpatient X-rays feature no copay, diagnostic procedures carry a $0 to $45 copay with no coinsurance, and therapeutic radiological services require a minimum $15 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Total Complete H4461-043 (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Total Complete H4461-043 (HMO) features no coinsurance and a $10 copay for cardiac rehabilitation services, though prior authorization is required. While some services are covered, 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 H4461-043 (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a daily copay of $218 for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Total Complete H4461-043 (HMO) partially covers other services, offering acupuncture for a $15 copay and no coinsurance (up to 20 treatments per year) and chronic illness meal benefits with no copay and no coinsurance. Both covered services require prior authorization, while over-the-counter (OTC) items are not covered.
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