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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 Colorado. This plan received an overall rating of 3 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 $0.00. 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 $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:
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Drug Coverage
The HealthSpring TotalCare (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay when utilizing preferred retail pharmacies or preferred mail order services. If standard pharmacies or standard mail order services are used, copays range from $5 to $15 for Tier 1 and $10 to $30 for Tier 2 depending on the supply duration. For Tier 3 preferred brand, Tier 4 non-preferred, and Tier 5 specialty drugs, the plan requires a flat 25% coinsurance. This 25% coinsurance applies to all preferred and standard pharmacy options, including mail order. Specialty tier medications are covered at this same coinsurance rate and are limited to a one-month supply.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers comprehensive medical coverage with no copay or coinsurance for primary care, specialists, preventive care, home health services, and dental care up to a $1,500 annual limit. Routine vision exams and eyewear are also covered with no copay up to a $300 yearly limit, while prescription hearing aids require copays starting at $399. For inpatient hospital stays, members pay a $180 daily copay for the first five days and no copay for days six through ninety. Emergency room visits require a $140 copay, which is waived upon hospital admission, while urgent care services feature a low $15 copay. Essential services like dialysis and durable medical equipment carry a 20% coinsurance, whereas Medicare Part B drugs range from 0% to 20% coinsurance. Additionally, the plan provides valuable extra benefits including up to 50 free one-way transportation trips per year to plan-approved locations and a $110 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $180 daily copay for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services with no copay and no coinsurance for ambulatory surgical center and outpatient blood services. Outpatient hospital and observation services feature no coinsurance with copays ranging from no copay up to $190, while outpatient substance abuse services require a 20% coinsurance and no copay.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring TotalCare (HMO D-SNP) with a $130.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
HealthSpring TotalCare (HMO D-SNP) covers ground ambulance services with a $205 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services are partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $140 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a $15 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $140 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care, specialist, therapy, and telehealth services with no copay and no coinsurance, while opioid treatment requires a 20% coinsurance with no copay. Chiropractic, mental health, and psychiatric services are partially covered under this plan, as routine chiropractic care and both individual and group therapy sessions are not covered.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and physical or memory fitness benefits, with no copay and no coinsurance. However, this benefit is only partially covered because it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety modifications, and counseling.
Hearing Services See details
HealthSpring TotalCare (HMO D-SNP) offers partially covered hearing services, including one annual routine exam and fitting evaluation with no deductible, copay, or coinsurance. Up to two prescription hearing aids per year are covered with no coinsurance and a copay ranging from $399.00 to $1,800.00, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered for up to two devices annually with a $399.00 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring TotalCare (HMO D-SNP) with no copay, no coinsurance, and no deductible for covered services. The plan covers one routine eye exam per year and up to $300 annually for eyewear, including contacts and one pair of eyeglasses, but other eye exam services are not covered.
Dental Services See details
Dental services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, up to a maximum annual benefit of $1,500. This coverage includes preventive care, exams, and cleanings, as well as comprehensive treatments such as restorative services, implants, and orthodontics, all with no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the HealthSpring TotalCare (HMO D-SNP) plan with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HealthSpring TotalCare (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
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 with no copay and a 20% coinsurance for therapeutic shoes and inserts, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring TotalCare (HMO D-SNP) with prior authorization required, as therapeutic radiological services and outpatient X-ray services are not covered. Diagnostic procedures and tests require a copay with no coinsurance, diagnostic radiological services have no copay and no coinsurance, and lab services feature no copay but require coinsurance.
Home Health Services See details
Home Health Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD 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 $20 daily copay for days 1 through 20 and a $214 daily copay for days 21 through 100. Prior authorization is required, a three-day prior inpatient hospital stay is not necessary, and additional days beyond the 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 a $110 quarterly over-the-counter (OTC) item allowance with no copay and no coinsurance. Acupuncture, highly integrated dual eligible SNP services, and other miscellaneous services are not covered under this plan benefit.
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