A non-government entity
Humana Total Complete H4461-064 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Humana Total Complete H4461-064 (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 H4461-064 (HMO) in 2026, please refer to our full plan details page.
Humana Total Complete H4461-064 (HMO) is a HMO plan offered by Humana Inc. available for enrollment in 2026 to people living in Albuquerque. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Humana Total Complete H4461-064 (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 H4461-064 (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 H4461-064 (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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3800.00 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 H4461-064 (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 H4461-064 (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you pay no copay for 1-month or 3-month supplies at standard pharmacies and through preferred mail order. Tier 2 generic drugs are also highly affordable, costing an $8 copay for a 1-month supply at standard pharmacies, with 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, though you can save on a 3-month supply through preferred mail order with a $94 copay. For Tier 4 non-preferred drugs, you will pay a 50% coinsurance across standard pharmacies and mail-order options. Tier 5 specialty drugs carry a 33% coinsurance for a 1-month supply across all available pharmacy and mail-order channels.
Additional Benefits
The Humana Total Complete H4461-064 (HMO) plan offers robust coverage with no copays for primary care visits, preventive services, routine vision exams, and home health care. Specialist visits are highly affordable with a low $15 copay, and routine dental care is largely covered with no copay up to a $2,500 yearly limit. Additionally, diagnostic lab tests and outpatient X-rays are available with no copay, making routine health maintenance very cost-effective. For more intensive medical needs, inpatient hospital stays require a $325 copay per day for the first six days, followed by no copay for days seven through ninety. Emergency room visits have a $115 copay, which is waived if you are admitted, while ground ambulance services require a $335 copay. Durable medical equipment, diabetic supplies, and dialysis services feature coinsurance ranging from 10% to 20% with no copays.
Inpatient Hospital See details
Humana Total Complete H4461-064 (HMO) offers partially covered inpatient hospital benefits with no coinsurance, requiring a $325 copay for days 1 to 6 and no copay for days 7 to 90. While unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Humana Total Complete H4461-064 (HMO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $325 (including a $325 copay per stay for observation services), and outpatient substance abuse sessions have a copay of $25 to $35, with prior authorization required for most benefits.
Partial Hospitalization See details
Partial hospitalization is covered by Humana Total Complete H4461-064 (HMO) with a $35.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Humana Total Complete H4461-064 (HMO) covers ground ambulance services with a $335 copay and air ambulance services with a $630 copay, with no coinsurance required for either service. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Humana Total Complete H4461-064 (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 $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are all covered with a $115 copay and no coinsurance.
Primary Care See details
Humana Total Complete H4461-064 (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 $30 copay and no coinsurance, while routine and other chiropractic services are not covered.
Preventive Services See details
Humana Total Complete H4461-064 (HMO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. This benefit is partially covered, as sub-services such as health education, weight management programs, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Humana Total Complete H4461-064 (HMO) covers Medicare-covered hearing exams for a $15 copay and no coinsurance, while routine exams, fitting evaluations, and OTC hearing aids are available with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $599 and $899 for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Humana Total Complete H4461-064 (HMO) offers partially covered vision services with no deductibles, no coinsurance, and no copays for covered benefits. Annual routine eye exams (one per year) and eyewear (one pair of contact lenses or eyeglasses per year up to a $250 combined maximum) are covered, while other eye exams, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
Humana Total Complete H4461-064 (HMO) dental services are partially covered up to a $2,500 yearly limit, requiring a $15 copay and no coinsurance for Medicare-covered dental, no copay and 30% coinsurance for prosthodontics, and no copay and no coinsurance for most other services. Fluoride treatments, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Humana Total Complete H4461-064 (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs require a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Humana Total Complete H4461-064 (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Humana Total Complete H4461-064 (HMO) covers medical equipment, including durable medical equipment (DME) and medical supplies with a 15% coinsurance and no copay. Prosthetic devices are covered with a 20% coinsurance and no copay, while diabetic supplies require a 10% to 20% coinsurance with no copay, and diabetic therapeutic shoes or inserts have a $10 copay.
Diagnostic and Radiological Services See details
Humana Total Complete H4461-064 (HMO) covers diagnostic and radiological services with prior authorization required, offering no copay for lab services and outpatient X-rays. Diagnostic tests feature no coinsurance and a copay ranging from $0 to $100, while therapeutic radiology services require a minimum 20% coinsurance and a $30 copay.
Home Health Services See details
Home health services are covered under the Humana Total Complete H4461-064 (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the Humana Total Complete H4461-064 (HMO) plan require prior authorization and have no copay or coinsurance. However, only some services are covered, and standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Humana Total Complete H4461-064 (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, though a prior three-day hospital stay is not required.
Other Services See details
Humana Total Complete H4461-064 (HMO) partially covers other services, offering acupuncture for a $15 copay and no coinsurance for up to 20 treatments per year, as well as over-the-counter items and chronic illness meals with no copay and no coinsurance. Other miscellaneous services and dual eligible SNPs with highly integrated services are not covered.
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