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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 2026 to people living in St. Louis. 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 $2.60. 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 (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay at preferred pharmacies or through preferred mail order, though standard pharmacies charge a $19 copay for a one-month supply. Tier 2 generic drugs require a $20 copay for a one-month supply, but you can get a three-month supply with no copay through preferred mail order. Higher-tier medications require coinsurance rather than flat copays. Tier 3 preferred brand-name drugs have a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates apply across all pharmacy and mail order options, with specialty drugs limited to a one-month supply.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers robust coverage with no copay and no coinsurance for primary care, specialist visits, preventive services, and home health care. For emergency care, members pay a $115 copay with no coinsurance, while urgent care visits require a $40 copay. Inpatient hospital stays feature Medicare-defined copays with no coinsurance, and outpatient hospital services generally carry no copay and a 0% to 20% coinsurance. This plan also provides excellent supplemental benefits, including comprehensive dental care up to $4,000 annually and routine vision exams with a $450 eyewear allowance, both with no copay and no coinsurance. Additionally, members can access unlimited transportation to approved health locations and receive up to $275 every three months for over-the-counter items with no copay. Routine hearing exams feature no copay, while hearing aids require copays ranging from $399 to $1,800.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) offers partially covered inpatient hospital services, featuring Medicare-defined copays and no coinsurance per admission for acute and psychiatric stays. Prior authorization is required, and additional days, non-Medicare-covered stays, and acute upgrades are not covered.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services with no copays, though prior authorization is required for most services. 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 have no coinsurance.
Partial Hospitalization See details
HealthSpring TotalCare (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring TotalCare (HMO D-SNP), featuring a 20% coinsurance and no copay for both ground and air ambulance services. Unlimited one-way transportation to plan-approved health-related locations is offered with no copay and no coinsurance, though trips to non-approved health-related locations are not covered.
Emergency Services See details
Emergency services are covered under the HealthSpring TotalCare (HMO D-SNP) plan 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 (HMO D-SNP) covers primary care, specialist care, occupational therapy, physical therapy, speech-language pathology, and telehealth services with no copay and no coinsurance. Opioid treatment program services are covered with no copay and 20% coinsurance, while chiropractic, mental health, psychiatric, and podiatry services are not covered.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) covers preventive services, including annual physical exams, kidney education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering fitness programs and caregiver support, while excluding 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 benefits, palliative care, in-home support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
HealthSpring TotalCare (HMO D-SNP) covers annual routine hearing exams and fittings with no copay and no coinsurance. Hearing aid benefits are partially covered with no coinsurance, offering up to two OTC hearing aids per year for a $399 copay and up to two prescription hearing aids per year with a copay between $399 and $1,800, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring TotalCare (HMO D-SNP), featuring no copay and no coinsurance for one routine eye exam per year and eyewear, though other eye exam services are not covered. The plan provides a $450 annual maximum coverage limit for contacts, lenses, frames, and upgrades with no deductible.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) covers comprehensive dental services, including preventive, restorative, implants, and orthodontic care, with no copay and no coinsurance. These covered benefits are subject to a maximum plan benefit of $4,000 per year.
Home Infusion bundled Services See details
HealthSpring TotalCare (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from 0% to 20%, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under HealthSpring TotalCare (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and 20% coinsurance, subject to prior authorization. This benefit is partially covered, as diabetic supplies are not covered, and diabetic equipment is limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring TotalCare (HMO D-SNP) because outpatient X-ray services are not covered and prior authorization is required. Diagnostic procedures require a copay with no coinsurance, therapeutic radiological services carry a 20% coinsurance with no copay, diagnostic radiological services have no copay and no coinsurance, and lab services require no copay.
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 Cardiac Rehabilitation Services with no copay and no coinsurance, though only some services are covered in practice as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. A prior three-day inpatient hospital stay is not required for admission, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers Other Services, offering a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $275 every three months for approved items, and the meal benefit is available for members with qualifying medical conditions.
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