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Humana Total Complete H4461-051 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Total Complete H4461-051 (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 H4461-051 (HMO) in 2026, please refer to our full plan details page.
Humana Total Complete H4461-051 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Dallas area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Total Complete H4461-051 (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 H4461-051 (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 H4461-051 (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 $3200.00 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 H4461-051 (HMO) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay for 1-month and 3-month supplies at standard pharmacies or through preferred mail order. Tier 2 generic drugs cost as little as a $5 copay for a 1-month supply, and members enjoy no copay for a 3-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a $45 copay for a 1-month supply at standard pharmacies and preferred mail order. For higher-tier prescriptions, Tier 4 non-preferred drugs have a 48% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a 1-month supply across all pharmacy and mail-order options.
Additional Benefits
The Humana Total Complete H4461-051 (HMO) plan offers robust medical coverage featuring no copay for primary care visits, preventive services, and home health care, while specialist visits require a $15 copay. For hospital care, inpatient stays carry a $225 daily copay for the first five days with no copay thereafter, and outpatient hospital services range from no copay up to a $200 copay. Emergency room visits have a $150 copay, which is waived if you are admitted, and ground ambulance services require a $335 copay. This plan also includes valuable supplemental benefits, such as dental coverage with no copay for most preventive and comprehensive services up to a $2,500 annual limit. Vision care features no copay for routine exams and eyewear up to a $150 annual limit, and routine hearing exams and over-the-counter hearing aids are also covered with no copay. Additionally, members can access acupuncture, over-the-counter items, and up to 24 one-way transportation trips per year with no copay.
Inpatient Hospital See details
Humana Total Complete H4461-051 (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $225 copay per day for days 1 through 5 and no copay for days 6 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services under the Humana Total Complete H4461-051 (HMO) plan are covered with no coinsurance, featuring a $0 to $200 copay for outpatient hospital services and a $225 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse services have a $20 to $35 copay per session with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by Humana Total Complete H4461-051 (HMO) 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 H4461-051 (HMO) covers ground ambulance services with a $335 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by Humana Total Complete H4461-051 (HMO) 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 H4461-051 (HMO) features primary care physician visits with no copay and no coinsurance, while specialist visits require a $15 copay and no coinsurance. Physical, occupational, and speech therapy services are covered with a $25 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by Humana Total Complete H4461-051 (HMO) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, fitness benefits, and glaucoma screenings. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by Humana Total Complete H4461-051 (HMO), featuring routine exams and OTC hearing aids with no copay and no coinsurance. Medicare-covered exams require a $15 copay and no coinsurance, while prescription hearing aids are partially covered with a $499 to $799 copay and no coinsurance, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
Humana Total Complete H4461-051 (HMO) provides partially covered vision services with no deductible and no coinsurance, though prior authorization is required. Routine eye exams, contact lenses, and eyeglasses are covered with no copay (up to a $150 annual limit for eyewear), while other eye exams, individual eyeglass lenses, frames, and upgrades are not covered.
Dental Services See details
Humana Total Complete H4461-051 (HMO) partially covers dental services with no copay and no coinsurance for most preventive and comprehensive care up to a $2,500 annual limit, while Medicare-covered dental services require a $15 copay and no coinsurance. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Humana Total Complete H4461-051 (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, require no coinsurance to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by the Humana Total Complete H4461-051 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Humana Total Complete H4461-051 (HMO) covers durable medical equipment and prosthetic devices with a 20% coinsurance and no copay. Diabetic supplies are covered with a 10% to 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts require a $10 copay and applicable coinsurance.
Diagnostic and Radiological Services See details
Humana Total Complete H4461-051 (HMO) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, no copay for labs, and a $0 to $100 copay for procedures. Radiological services range from no copay for outpatient X-rays and diagnostic radiology to a minimum 20% coinsurance and $15 copay for therapeutic radiological services.
Home Health Services See details
Humana Total Complete H4461-051 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Humana Total Complete H4461-051 (HMO) technically covers Cardiac Rehabilitation Services with no coinsurance and prior authorization, but in practice, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Humana Total Complete H4461-051 (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copayment for days 21 through 100. Prior authorization is required, a three-day prior inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Humana Total Complete H4461-051 (HMO) partially covers other services, offering acupuncture (up to 25 treatments per year), over-the-counter items, and meal benefits with no copay and no coinsurance. Prior authorization is required for acupuncture and meals, while unspecified other services and Dual Eligible SNPs with Highly Integrated Services are not covered.
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