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HealthSpring TotalCare Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring TotalCare Plus (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 Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
HealthSpring TotalCare Plus (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 Plus (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 Plus (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 Plus (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 Plus (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 $9250.00 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 HealthSpring TotalCare Plus (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you pay no copay when using a preferred pharmacy or preferred mail order service, while standard options require a $19 copay for a one-month supply. Tier 2 generic drugs carry a $20 copay for a one-month supply, though you can receive a three-month supply with no copay through preferred mail order. For Tier 3 preferred brand drugs, you will pay a 23% coinsurance regardless of the pharmacy or supply duration you choose. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance, with specialty medications restricted to a one-month supply.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers comprehensive medical coverage with no copay for primary care, specialist visits, outpatient services, and dialysis, though these services typically require a 20% coinsurance. Inpatient hospital stays are covered with no coinsurance, while emergency room visits require a $115 copay and urgent care visits carry a $40 copay. Home health care and skilled nursing facility stays are fully covered with no copay and no coinsurance. Additionally, this plan provides valuable extra benefits including preventive and comprehensive dental care with no copay and no coinsurance up to a $3,250 annual maximum. Vision benefits feature no copays and a $500 annual allowance for eyewear, while routine transportation offers up to 30 one-way trips per year with no copay or coinsurance. Members also benefit from a $225 quarterly over-the-counter allowance and covered hearing aids starting at a $399 copay with no coinsurance.
Inpatient Hospital See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required and Medicare-defined copayments apply. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers outpatient services with no copays, though coinsurance and prior authorization apply to most benefits. Outpatient hospital and ambulatory surgical center services carry a 0% to 20% coinsurance, outpatient substance abuse services require a 20% coinsurance, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
HealthSpring TotalCare Plus (HMO D-SNP) covers partial hospitalization services with an $80.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay under prior authorization. Transportation services are partially covered, offering up to 30 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
Emergency services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) covers primary care, specialist, occupational therapy, physical therapy, speech-language, and opioid treatment services with no copay and 20% coinsurance. Other professional and telehealth services are covered with no copay and 0% to 20% coinsurance, while podiatry, chiropractic, psychiatric, and mental health specialty services are not covered.
Preventive Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Medicare preventive services, kidney disease education, and select screenings with no copay and no coinsurance, though the annual physical exam requires a 20% coinsurance and no copay. Additional preventive services are partially covered with no copay and no coinsurance, which includes fitness and caregiver support, but excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge 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, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers hearing services, offering routine hearing exams with no copay and 20% coinsurance, alongside OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision Services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copays, featuring eyewear with no coinsurance up to a $500 annual limit. Eye exams are partially covered with a 0% to 20% coinsurance for routine annual exams, though other eye exam services are not covered.
Dental Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Medicare-covered dental services with no copay and 20% coinsurance. Other preventive and comprehensive dental services, including cleanings, exams, and implants, are covered with no copay and no coinsurance up to a maximum benefit of $3,250 every year.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
HealthSpring TotalCare Plus (HMO D-SNP) covers medical equipment with no copay and 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes and inserts. This benefit is partially covered because diabetic supplies are not covered, and prior authorization is required.
Diagnostic and Radiological Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers diagnostic and radiological services, with prior authorization required for all services. Diagnostic procedures require a copay with no coinsurance, while lab services feature no copay but do carry a coinsurance. Diagnostic radiological services have no copay and no coinsurance, whereas therapeutic radiological services and outpatient X-rays require a 20% minimum coinsurance and no copay.
Home Health Services See details
Home Health Services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 20% coinsurance. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. This benefit allows for admission with less than a three-day prior hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers other services, offering a meal benefit and an over-the-counter (OTC) allowance of up to $225 every three months with no copay and no coinsurance. Acupuncture and certain other services under this category are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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