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Humana Total Complete H4461-046 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Total Complete H4461-046 (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 H4461-046 (HMO) in 2026, please refer to our full plan details page.
Humana Total Complete H4461-046 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Select Counties in Missouri. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Total Complete H4461-046 (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 H4461-046 (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 H4461-046 (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 $2.00. 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 $2700.00 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 H4461-046 (HMO) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for a 1-month or 3-month supply at standard pharmacies or through preferred mail order. Tier 2 generic drugs are also budget-friendly, costing a $5 copay for a 1-month supply at standard pharmacies and offering no copay for a 3-month supply filled through preferred mail order. For brand-name and specialty medications, costs are structured as copays or coinsurance depending on the tier. Tier 3 preferred brand drugs have a $47 copay for a 1-month supply, with a discounted $131 copay for a 3-month supply through preferred mail order. Tier 4 non-preferred drugs require 50% coinsurance, while Tier 5 specialty drugs require 25% coinsurance for a 1-month supply across all pharmacy and mail order channels.
Additional Benefits
The Humana Total Complete H4461-046 (HMO) plan offers robust coverage for core medical needs with predictable out-of-pocket costs and no coinsurance for many services. You will pay no copay for primary care visits and preventive care, while specialist visits require a $25 copay. Inpatient hospital stays feature a $375 daily copay for the first seven days of acute care, and emergency room visits carry a $130 copay which is waived if you are admitted. This plan also provides valuable supplemental benefits, including up to a $4,000 annual dental limit with no copay for most preventive and comprehensive services. Routine vision and hearing exams are available with no copay, and the plan features a $150 annual eyewear allowance alongside affordable prescription hearing aid options. Additionally, members can access home health services, over-the-counter items, and chronic illness meal benefits with no copay or coinsurance.
Inpatient Hospital See details
Humana Total Complete H4461-046 (HMO) partially covers inpatient hospital services with no coinsurance, featuring a daily copay of $375 for days 1 to 7 of acute care and $334 for days 1 to 7 of psychiatric care, with no copay for remaining covered days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Total Complete H4461-046 (HMO) covers outpatient hospital services with a $0 to $300 copay and no coinsurance, and observation services with a $375 copay per stay and no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 to $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Total Complete H4461-046 (HMO) with a $35.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Humana Total Complete H4461-046 (HMO) covers ambulance services with a $335 copayment for ground transport and a 20% coinsurance for air transport, with prior authorization required. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Humana Total Complete H4461-046 (HMO) are covered with a $130 copay and no coinsurance, and the copay is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $130 copay and no coinsurance.
Primary Care See details
Humana Total Complete H4461-046 (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, mental health, and psychiatric therapies are covered with a $30 copay and no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Humana Total Complete H4461-046 (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. While a memory fitness benefit is covered, several additional supplemental services, such as health education, in-home safety assessments, and personal emergency response systems, are not covered.
Hearing Services See details
Humana Total Complete H4461-046 (HMO) covers hearing exams with a $25 copay and no coinsurance, though routine annual exams and fitting evaluations have no copay. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999, but inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered with no copay and no coinsurance.
Vision Services See details
Vision services are partially covered by the Humana Total Complete H4461-046 (HMO) plan, featuring no copays, no coinsurance, and no deductibles for covered benefits. This benefit includes one routine eye exam and a $150 annual allowance for contact lenses or eyeglasses (lenses and frames) per year, but other eye exams, standalone eyeglass lenses, standalone eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Humana Total Complete H4461-046 (HMO), offering up to a $4,000 annual limit with no copay and no coinsurance for most preventive and comprehensive care, while prosthodontics require a 30% coinsurance and no copay, and Medicare-covered dental has a $25 copay and no coinsurance. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Total Complete H4461-046 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require no coinsurance to 20% coinsurance, with insulin also having a $35 copay.
Dialysis Services See details
Humana Total Complete H4461-046 (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 H4461-046 (HMO) covers durable medical equipment and prosthetic devices with a 20% coinsurance and no copay, while medical supplies carry a 15% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, and diabetic therapeutic shoes or inserts require a $10 copay.
Diagnostic and Radiological Services See details
Humana Total Complete H4461-046 (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays feature no copay, while diagnostic procedures range from a $0 to $65 copay and therapeutic radiology has a minimum copay of $25.
Home Health Services See details
Humana Total Complete H4461-046 (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Total Complete H4461-046 (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD are not covered, with copays ranging from no copay up to $30.
Skilled Nursing Facility (SNF) See details
Humana Total Complete H4461-046 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Humana Total Complete H4461-046 (HMO) provides partially covered other services, featuring acupuncture with a $25 copay and no coinsurance, alongside over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meal benefits, while Other 1, Other 2, Other 3, and Dual Eligible SNPs with Highly Integrated Services are not covered.
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