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Humana Total Complete H4461-049 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Total Complete H4461-049 (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 H4461-049 (HMO) in 2026, please refer to our full plan details page.
Humana Total Complete H4461-049 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Fort Bend, Harris and Jefferson counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Total Complete H4461-049 (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 H4461-049 (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 H4461-049 (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 $3400.00 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 H4461-049 (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 and through preferred mail order. Tier 2 generic drugs are highly affordable, costing a $5 copay for a 1-month supply at standard pharmacies and preferred mail order, with no copay required for a 3-month supply through preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a 1-month supply, while 3-month supplies cost $141 at standard pharmacies or a reduced $131 through preferred mail order. For higher-tier medications, members pay coinsurance rather than a flat copayment. Tier 4 non-preferred drugs require 48% coinsurance, and Tier 5 specialty drugs require 25% coinsurance for a 1-month supply.
Additional Benefits
The Humana Total Complete H4461-049 (HMO) plan offers comprehensive medical coverage with no copay for primary care visits and a low $15 copay for specialists. Preventive services, routine physicals, and home health care are covered with no copays or coinsurance. For hospital stays, inpatient admissions require a $350 copay, while outpatient hospital services range from no copay up to $200. Supplemental benefits include dental care up to a $3,000 annual limit and vision eyewear up to a $400 annual limit, both with no copays. Members also benefit from routine hearing exams and up to 60 one-way transportation trips per year at no cost. Durable medical equipment carries a 20% coinsurance, and skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Humana Total Complete H4461-049 (HMO) covers inpatient acute and psychiatric hospital stays with a $350 copay per admission and no coinsurance, though prior authorization is required. The benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Humana Total Complete H4461-049 (HMO) covers outpatient services with no coinsurance, although prior authorization is required. Outpatient hospital services feature copays from $0 to $200, observation services cost $350 per stay, substance abuse sessions range from $20 to $35, and ambulatory surgical center and blood services have no copay.
Partial Hospitalization See details
Humana Total Complete H4461-049 (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 H4461-049 (HMO) covers ground and air ambulance services with a $335 copay and no coinsurance. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
Humana Total Complete H4461-049 (HMO) covers emergency services with a $150 copay and no coinsurance, with the copay 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 covered with a $150 copay and no coinsurance.
Primary Care See details
Humana Total Complete H4461-049 (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $15 copay and no coinsurance. Physical, occupational, and speech therapy services require a $25 copay with no coinsurance, while mental health services carry a $20 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Humana Total Complete H4461-049 (HMO) covers preventive services, annual physical exams, kidney disease education, and select screenings with no copay and no coinsurance. Additional preventive benefits are partially covered, providing a fitness benefit with no copay or coinsurance, but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, in-home medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home/bathroom safety modifications, and counseling services.
Hearing Services See details
Humana Total Complete H4461-049 (HMO) covers hearing services with no coinsurance, offering Medicare-covered exams for a $15 copay, alongside routine exams, fitting evaluations, and OTC hearing aids with no copay. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $0 to $599, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Humana Total Complete H4461-049 (HMO) partially covers vision services, offering one routine eye exam and eyewear like contact lenses or eyeglasses with no copay, no coinsurance, and no deductible, up to a $400 annual limit. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Total Complete H4461-049 (HMO) partially covers dental services up to a $3,000 annual limit, featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services. Fluoride treatments, removable prosthodontics, maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Humana Total Complete H4461-049 (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Humana Total Complete H4461-049 (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Humana Total Complete H4461-049 (HMO) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, though prior authorization is required. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts carry a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Humana Total Complete H4461-049 (HMO) covers diagnostic and radiological services, requiring prior authorization for these benefits. Lab services, outpatient X-rays, and diagnostic radiological services have no copay, diagnostic procedures range from a $0 to $150 copay with no coinsurance, and therapeutic radiological services require at least a $15 copay and 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Humana Total Complete H4461-049 (HMO) plan 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 H4461-049 (HMO) with no coinsurance, and while some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a $20 copay. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Total Complete H4461-049 (HMO) with no coinsurance, requiring prior authorization but allowing admission with less than a three-day prior hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare limit are not covered.
Other Services See details
Humana Total Complete H4461-049 (HMO) partially covers other services with no copay and no coinsurance, which includes acupuncture limited to 12 treatments per year, over-the-counter items, and chronic illness meal benefits. However, sub-services such as Dual Eligible SNPs with Highly Integrated Services and other unspecified services are not covered.
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