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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 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 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 $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 Plus (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when filling a prescription at a preferred pharmacy or through preferred mail order, though standard pharmacies charge a $19 copay for a one-month supply. Tier 2 generic drugs generally carry a $20 copay for a one-month supply, but you can receive a three-month supply with no copay via preferred mail order. Brand-name and higher-tier medications require coinsurance under this plan rather than flat copayments. Tier 3 preferred brands have a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance across all pharmacy and mail order networks. Understanding these copay and coinsurance tiers can help you maximize your savings on the HealthSpring TotalCare Plus (HMO D-SNP) plan.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers comprehensive medical coverage featuring no copayments for primary care, specialist visits, and outpatient services, though coinsurance up to 20% may apply. Inpatient hospital stays require Medicare-defined copays with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Additionally, essential services like home health care and skilled nursing facility stays are fully covered with no copay and no coinsurance. This plan also provides robust supplemental benefits, including preventive and comprehensive dental care up to a $4,000 annual limit with no copay and no coinsurance. Routine vision and hearing exams are available with no copay and coinsurance up to 20%, alongside a $500 annual eyewear allowance and affordable copays for hearing aids. Members also benefit from unlimited transportation to plan-approved locations and a $400 quarterly allowance for over-the-counter items, both with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), which offers acute and psychiatric hospital stays with no coinsurance and Medicare-defined copayments, though prior authorization is required. Specific services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers outpatient services with no copays, although coinsurance and prior authorization may be required for certain treatments. Outpatient hospital and ambulatory surgical services have a 0% to 20% coinsurance, outpatient substance abuse services require a 20% coinsurance, and outpatient blood services are available with no coinsurance and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered under the HealthSpring TotalCare Plus (HMO D-SNP) plan with no copay and a 30% coinsurance. Prior authorization is required to access these services.
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. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare Plus (HMO D-SNP) 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 require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum limit with a $115 copay and no coinsurance per service.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) covers primary care, specialist, therapy, telehealth, and opioid treatment services with no copay and coinsurance ranging from no coinsurance to 20%. For chiropractic, mental health, and psychiatric benefits, some services are covered but routine chiropractic, other chiropractic services, and individual and group sessions are not covered. Routine podiatry is covered for up to six visits per year with no copay and 20% coinsurance.
Preventive Services See details
Preventive Services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), offering Medicare-covered preventive services, kidney disease education, caregiver support, and fitness benefits with no copay and no coinsurance, though an annual physical exam requires no copay and a 20% coinsurance. Several additional benefits are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems, and nutritional or weight management programs.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers annual routine hearing exams with no copay and a 20% coinsurance, as well as fitting evaluations. Prescription hearing aids are partially covered with a $399 to $1,800 copay and no coinsurance, though inner ear, outer ear, and over-the-ear types are not covered, while OTC hearing aids are available with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) offers partially covered vision services, as other eye exam services are not covered. One routine eye exam is covered annually with no copay, no deductible, and 0% to 20% coinsurance, while eyewear is covered with no copay, no coinsurance, no deductible, and a $500 annual maximum.
Dental Services See details
Dental services are covered by HealthSpring TotalCare Plus (HMO D-SNP), featuring no copay and a 20% coinsurance for Medicare-covered dental care. Comprehensive and preventive dental services, including exams, cleanings, and orthodontics, are covered with no copay and no coinsurance up to a $4,000 maximum annual benefit.
Home Infusion bundled Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical Equipment is partially covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and 20% coinsurance, subject to prior authorization. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers diagnostic and radiological services with prior authorization, offering diagnostic radiological services with no copay and no coinsurance. Lab services have no copay but require coinsurance, diagnostic tests require a copay with no coinsurance, and both therapeutic radiology and outpatient X-ray services carry a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered under the HealthSpring TotalCare Plus (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, but only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. The plan does not require a three-day prior inpatient hospital stay for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services under the HealthSpring TotalCare Plus (HMO D-SNP) are partially covered, offering a meal benefit and up to $400 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and other miscellaneous services are not covered under this benefit.
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