A non-government entity
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 Ohio. 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 $9100.00 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:
Sign up for HealthSpring TotalCare (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HealthSpring TotalCare (HMO D-SNP) Medicare prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail order services, while standard pharmacies require a $19 copay for a one-month supply. Tier 2 generic drugs generally carry a $20 copay for a one-month supply, though a three-month supply is available with no copay through preferred mail order. Brand-name and specialty medications are covered under coinsurance rather than flat copayments. 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 percentages remain consistent across all standard and preferred pharmacy and mail order channels.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers robust coverage with no copays or coinsurance for many essential services, including primary care visits, preventive care, home health, and skilled nursing facility stays. Beneficiaries also benefit from no copays or coinsurance for routine dental care up to $2,400 annually, routine hearing exams, and vision care with a $400 annual eyewear allowance. For other critical needs like outpatient services, durable medical equipment, and dialysis, the plan charges no copay but requires a 20% coinsurance. For emergency and urgent care, members will pay a predictable flat copay of $115 for emergency room visits, which is waived if admitted, and $40 for urgent care. Additionally, the plan includes valuable extra benefits like up to 40 one-way transportation trips to plan-approved locations and a $150 quarterly over-the-counter allowance at no copay or coinsurance. Prior authorizations are required for several services, including inpatient hospital stays, which are subject to Medicare-defined copays.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HealthSpring TotalCare (HMO D-SNP) with Medicare-defined copays and no coinsurance, requiring prior authorization per admission. This benefit does not cover upgrades, additional days, or non-Medicare-covered stays.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services with no copay, though prior authorization is required for most services and coinsurance ranges from 0% to 20%. Outpatient hospital, ambulatory surgical, and substance abuse services require up to 20% coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
HealthSpring TotalCare (HMO D-SNP) covers partial hospitalization services with an $80.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
HealthSpring TotalCare (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 40 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by HealthSpring TotalCare (HMO D-SNP) 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 lifetime maximum with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care, specialist, therapy, telehealth, and routine podiatry services with no copay and no coinsurance, while opioid treatment requires no copay but has a 20% coinsurance. Some chiropractic, mental health, and psychiatric services are covered, but routine or other chiropractic care, and individual or group sessions for mental health and psychiatric services, are not covered.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, providing physical and memory fitness benefits but excluding health education, in-home safety assessments, PERS, 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, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
HealthSpring TotalCare (HMO D-SNP) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $399 and $1,800 for up to two devices per year, though inner ear, outer ear, and over the ear types are not covered. Up to two OTC hearing aids are also covered each year with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare (HMO D-SNP) provides partially covered vision services with no copay and no coinsurance, although other eye exam services are not covered. Covered benefits include one routine eye exam per year and up to $400 annually for eyewear, including contacts and eyeglasses, with no copay or coinsurance.
Dental Services See details
Dental services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance for preventive, diagnostic, and comprehensive care up to a maximum benefit of $2,400 per year. Medicare-covered dental services also feature no copay and no coinsurance, though prior authorization is required.
Home Infusion bundled Services See details
HealthSpring TotalCare (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy, radiation, and other Part B drugs have coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by 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 medical equipment with no copay and 20% coinsurance, subject to prior authorization. This benefit is partially covered because diabetic therapeutic shoes and inserts are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers diagnostic and radiological services with prior authorization required, though outpatient X-ray services are not covered. Diagnostic procedures and tests require a copayment with no coinsurance, lab services have no copay but require coinsurance, diagnostic radiological services have no copay or coinsurance, and therapeutic radiological services have no copay and a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, but prior authorization is required and only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and carry a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. The benefit is partially covered, as additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) covers select other services with no copay and no coinsurance, including meal benefits for qualifying medical conditions and up to $150 every three months for over-the-counter items. Acupuncture and other additional services in this category are not covered by the plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved