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HealthSpring TotalCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring TotalCare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring TotalCare (HMO D-SNP) in 2026, please refer to our full plan details page.
HealthSpring TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Georgia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HealthSpring TotalCare (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HealthSpring TotalCare (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthSpring TotalCare (HMO D-SNP).
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 HealthSpring TotalCare (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $3.40. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $6750.00 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 prescription drug coverage for the HealthSpring TotalCare (HMO D-SNP) plan includes an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay when utilizing preferred pharmacies or preferred mail order, whereas standard pharmacies require a $19 copay for a one-month supply. Tier 2 generic drugs incur a $20 copay for a one-month supply, though you can benefit from no copay for a three-month supply through preferred mail order. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. These coinsurance rates remain the same whether you fill your prescriptions at a preferred pharmacy, standard pharmacy, or via mail order.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers comprehensive coverage with no copays or coinsurance for primary care, specialist visits, and preventive services. For hospital care, inpatient acute stays require a $1,775 copay per stay with no coinsurance, while outpatient hospital services feature no copays and a 0% to 20% coinsurance. Emergency room visits have a $130 copay which is waived if you are admitted, and urgent care is available with a $50 copay. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay up to a $2,650 annual maximum. Vision and hearing services are covered with no copays for routine exams, plus you receive a $300 annual eyewear allowance and a $200 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) partially covers inpatient hospital services, as additional days, upgrades, and non-Medicare-covered stays are not covered. Covered acute stays require a $1,775 copayment per stay and no coinsurance, while psychiatric stays require an $1,850 copayment per stay and no coinsurance.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services with no copays, featuring a 0% to 20% coinsurance for outpatient hospital and ambulatory surgical center services, and a 20% coinsurance for observation services. Outpatient blood services require no copay or coinsurance, and while some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization services are covered by HealthSpring TotalCare (HMO D-SNP) with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under HealthSpring TotalCare (HMO D-SNP), with ground ambulance services requiring a $275 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Plan-approved transportation is partially covered with no copay or coinsurance for up to 30 one-way trips per year, though general transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with copayments waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum limit with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care, specialist visits, therapy, telehealth, and opioid treatment services with no copay and no coinsurance. Podiatry is not covered, and while some chiropractic, mental health, and psychiatric services are covered, routine and other chiropractic care as well as individual and group sessions are not covered.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, tobacco cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by HealthSpring TotalCare (HMO D-SNP), offering one routine exam and one fitting evaluation annually with no copay and no coinsurance. Prescription hearing aids are partially covered (excluding inner ear, outer ear, and over the ear types) with no coinsurance and a copay of $399.00 to $1,800.00 for up to two devices yearly, while OTC hearing aids are covered with a $399.00 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers vision services with no copay, no coinsurance, and no deductible, as other eye exam services are not covered. Covered benefits include one routine eye exam per year and up to a $300 annual allowance for eyewear, including contacts, frames, lenses, and upgrades.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) covers comprehensive and preventive dental services, including cleanings, exams, implants, and orthodontics, with no copay and no coinsurance. These dental services are subject to an annual maximum benefit of $2,650, and Medicare-covered dental services require prior authorization.
Home Infusion bundled Services See details
HealthSpring TotalCare (HMO D-SNP) covers Home Infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, insulin, and other Part B drugs feature a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the HealthSpring TotalCare (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered, meaning diabetic therapeutic shoes and inserts are covered with no copay and a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring TotalCare (HMO D-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures require a copay with no coinsurance, lab services have no copay but require coinsurance, and therapeutic radiology has a 20% coinsurance with no copay, while diagnostic radiology and X-rays feature no copays or coinsurance.
Home Health Services See details
Home Health Services are covered under the HealthSpring TotalCare (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed before admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HealthSpring TotalCare (HMO D-SNP), featuring a meal benefit and over-the-counter (OTC) items with a $200 quarterly limit, both with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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