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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 Ohio. This plan received an overall rating of 3 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 $0.90. 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) plan features an annual drug deductible of $615 and offers significant savings on Tier 1 preferred generic drugs, which have no copay when filled through a preferred pharmacy or preferred mail order. Standard pharmacies and standard mail orders charge a $19 monthly copay for Tier 1 drugs, while Tier 2 generic drugs require a $20 monthly copay at most locations. Additionally, you can receive a 3-month supply of Tier 2 generic medications with no copay when using preferred mail order. For higher-tier medications, you will pay a coinsurance instead of a flat copay, starting with a 23% coinsurance for Tier 3 preferred brand drugs. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance across all pharmacy and mail-order options. Tier 5 specialty medications are limited to a 1-month supply.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers comprehensive medical coverage, with many essential services requiring no copay, though coinsurance often applies. For example, primary care, specialist visits, and outpatient services feature no copay but typically carry a 20% coinsurance. Inpatient hospital stays and skilled nursing facility care are covered with no coinsurance, though Medicare-defined cost-sharing may apply to hospitalizations. Beneficiaries also receive robust supplemental benefits, including dental care with no copay and no coinsurance up to a $3,500 annual limit, alongside a $400 annual allowance for eyewear. Additionally, the plan provides up to 40 one-way trips for health-related transportation with no copay and a $175 quarterly allowance for over-the-counter items. Emergency room visits require a $115 copay with no coinsurance, which is waived if you are admitted to the hospital.
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 cost-sharing may apply. Additional hospital days, non-Medicare-covered stays, and room upgrades are not covered.
Outpatient Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers outpatient services with no copays, though coinsurance applies to several benefits. Outpatient hospital and ambulatory surgical services require 0% to 20% coinsurance, outpatient substance abuse services require 20% coinsurance, and outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring TotalCare Plus (HMO D-SNP) with an $80.00 copay and no coinsurance. Prior authorization is required for this benefit.
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, subject to prior authorization. Transportation services are partially covered, offering up to 40 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while 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, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum limit with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) covers primary care, specialist, therapy, podiatry, and telehealth services with no copay and 20% coinsurance (no coinsurance to 20% for telehealth). For chiropractic, psychiatric, and mental health specialty services, some services are covered with no copay and no coinsurance to 20% coinsurance, but routine chiropractic care, other chiropractic services, and individual or group sessions are not covered.
Preventive Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers preventive services, including Medicare-covered zero-dollar services, kidney disease education, and diabetes training with no copay and no coinsurance. The annual physical exam is covered with no copay and a 20% coinsurance. Additional preventive benefits are partially covered, offering physical and memory fitness with no copay and no coinsurance, but excluding most other supplemental services like health education and nutritional therapy.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers hearing services, including one routine hearing exam per year with no copay and a 20% coinsurance, and one fitting evaluation with no copay and no coinsurance. Prescription hearing aids are partially covered up to two per year with a $399 to $1,800 copay and no coinsurance, excluding inner ear, outer ear, and over the ear models. Up to two OTC hearing aids are also covered annually with a $399 copay and no coinsurance.
Vision Services See details
Vision Services under HealthSpring TotalCare Plus (HMO D-SNP) are partially covered, offering one routine eye exam per year with no copay and 0% to 20% coinsurance, while other eye exam services are not covered. Covered eyewear has no copay and no coinsurance, providing up to a $400 annual maximum benefit for contact lenses, upgrades, or one pair of eyeglasses per year.
Dental Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers dental services with no copay and no coinsurance for preventive and comprehensive care, up to a $3,500 annual maximum. Medicare-covered dental services are also covered with no copay and a 20% coinsurance, subject to prior authorization.
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 apply. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin requires 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, and prior authorization is required.
Medical Equipment See details
HealthSpring TotalCare Plus (HMO D-SNP) covers durable medical equipment and prosthetics with no copay and 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and 20% coinsurance for therapeutic shoes and inserts, though 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. Lab services and diagnostic radiological services are available with no copay or coinsurance, while diagnostic procedures and tests require a copay with no coinsurance. Therapeutic radiological and outpatient X-ray services are covered with a 20% 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 cardiac rehabilitation services with no copay, although prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and are subject to a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare Plus (HMO D-SNP) provides partially covered Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required. While a prior three-day inpatient hospital stay is not required for admission, 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 over-the-counter (OTC) items with a $175 quarterly allowance and limited-duration meal benefits with no copay and no coinsurance. Acupuncture and dual eligible SNPs with highly integrated services are not covered.
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