A non-government entity
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 $9150.00 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:
Sign up for Humana Total Complete H4461-043 (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Humana Total Complete H4461-043 (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at standard pharmacies and through preferred mail order. Tier 2 generic prescriptions are also highly affordable, with a low $5 copay for a 1-month supply at standard pharmacies, or no copay for a 3-month supply when using preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a 1-month supply across standard pharmacies and mail order options. For higher-tier medications, Tier 4 non-preferred drugs carry a 41% coinsurance, while Tier 5 specialty drugs require a 25% coinsurance. Understanding these tier-based copays and coinsurance rates helps you estimate your out-of-pocket prescription drug costs with this Humana Medicare plan.
Additional Benefits
The Humana Total Complete H4461-043 (HMO) plan offers medical coverage with no copay and no coinsurance for primary care visits, home health services, and preventive care. If you require specialist visits, inpatient hospital stays, or emergency care, you will pay predictable copays, such as a $25 copay for specialists and a $285 daily copay for the first six days of an inpatient hospital stay. Outpatient hospital services feature no coinsurance and a copay of up to $250. This plan also includes valuable supplemental benefits, including vision coverage with no copay up to a $400 annual limit, and dental services with no copay for preventive care up to a $2,000 yearly limit. Hearing exams are available with no copay, though prescription hearing aids require a copay between $399 and $699. For durable medical equipment and dialysis, members will pay a 20% coinsurance with no copay.
Inpatient Hospital See details
Humana Total Complete H4461-043 (HMO) covers inpatient hospital services with no coinsurance, requiring a $285 daily copay for days 1 to 6 and no copay for days 7 to 90. While unlimited additional acute care days are covered at no copay, additional psychiatric days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by Humana Total Complete H4461-043 (HMO) with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services and a $285 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while individual and group outpatient substance abuse sessions have a $35 copay and no coinsurance.
Partial Hospitalization See details
Humana Total Complete H4461-043 (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
Ambulance and transportation services are partially covered by Humana Total Complete H4461-043 (HMO), which offers ground ambulance services with a $335 copay and air ambulance services with a 20% coinsurance, subject to prior authorization. Routine transportation services to plan-approved or health-related locations are not covered.
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 are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are available for 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 $25 copay and no coinsurance. Physical, occupational, and speech therapies have a $20 copay and no coinsurance, mental health and psychiatric services feature a $35 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Humana Total Complete H4461-043 (HMO) provides preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes training. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness and in-home support, though sub-services such as health education, nutritional therapy, and personal emergency response systems are not covered.
Hearing Services See details
Humana Total Complete H4461-043 (HMO) covers hearing services, featuring a $25 copay and no coinsurance for Medicare-covered exams, plus routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $699 copay and no coinsurance for up to two devices per year, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
Humana Total Complete H4461-043 (HMO) partially covers vision services with no copay, no coinsurance, and no deductible for covered benefits, up to a $400 annual maximum. Covered benefits include one routine eye exam and one pair of contact lenses or eyeglasses (lenses and frames) per year, while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Total Complete H4461-043 (HMO) features partially covered dental services up to a $2,000 annual limit, offering no copay and no coinsurance for preventive care, endodontics, periodontics, and oral surgery, while excluding fluoride treatments, implants, maxillofacial prosthetics, and orthodontics. Medicare-covered dental services require a $25 copay and no coinsurance, whereas restorative and prosthodontic services have no copay and a 30% to 40% coinsurance.
Home Infusion bundled Services See details
Humana Total Complete H4461-043 (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Humana Total Complete H4461-043 (HMO) 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 and prosthetics with a 20% coinsurance and no copay, subject to prior authorization. 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. Lab services feature no copay and no coinsurance, diagnostic tests have a $0 to $45 copay with no coinsurance, and therapeutic radiological services require a minimum $25 copay and 20% coinsurance.
Home Health Services See details
Humana Total Complete H4461-043 (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 Total Complete H4461-043 (HMO) with no coinsurance, though prior authorization is required. While some services are covered, specific programs including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Total Complete H4461-043 (HMO) with no coinsurance and do not require a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though prior authorization is required and additional days are not covered.
Other Services See details
Humana Total Complete H4461-043 (HMO) offers partial coverage for other services, including acupuncture with a $25 copay and no coinsurance for up to 20 treatments per year, and a chronic illness meal benefit with no copay and no coinsurance. Over-the-counter (OTC) items are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved