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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 Baltimore. 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 $0.00. 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 $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. For Tier 1 preferred generics and Tier 2 generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service. If you choose a standard pharmacy or standard mail-order service, Tier 1 copays start at $5 and Tier 2 copays start at $10 for a one-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs carry a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. These coinsurance rates remain the same whether you use preferred or standard pharmacies or mail-order options.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers comprehensive coverage with no copay for inpatient hospital stays, home health care, and skilled nursing facility visits. Routine primary and specialist care require no copay but are subject to a 20% coinsurance, which also applies to dialysis, durable medical equipment, and outpatient services. Emergency room visits carry a $115 copay that is waived upon admission, while urgent care services require a $40 copay. For additional wellness benefits, the plan features dental coverage with no copay or coinsurance up to a $20,000 annual limit, and vision services with no copay and a $300 eyewear allowance. Hearing exams have no copay with a 20% coinsurance, while hearing aids require copays ranging from $399 to $1,800. Members also receive extra perks with no copay or coinsurance, including up to 50 one-way transportation trips per year and a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, subject to prior authorization. This benefit does not cover additional days, non-Medicare-covered stays, or room upgrades.
Outpatient Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers outpatient services with no copays, though a coinsurance of up to 20% applies to outpatient hospital, observation, ambulatory surgical, and substance abuse services. Outpatient blood services are fully 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 to receive 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 with no copay or coinsurance for up to 50 one-way trips per year to plan-approved health-related locations, though 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 with no coinsurance, while 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 Plus (HMO D-SNP) covers primary care, specialist, psychiatric, and therapy services with no copay and 20% coinsurance, with prior authorization required for most specialized care. Chiropractic services are not covered, but routine podiatry is covered for up to 12 visits per year with no copay and 20% coinsurance.
Preventive Services See details
HealthSpring TotalCare Plus (HMO D-SNP) provides preventive services with no copay and no coinsurance for most benefits, including kidney disease education, while the annual physical exam has no copay but requires a 20% coinsurance. Additional preventive services are partially covered, offering fitness benefits and caregiver support with no copay or coinsurance, 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 benefits, home-based palliative care, in-home support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access, home and bathroom safety devices, and counseling.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers hearing exams with no copay and a 20% coinsurance for routine visits, alongside covered fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $399.00 to $1,800.00 for up to two devices yearly, excluding inner ear, outer ear, and over the ear models. OTC hearing aids are also available with a $399.00 copay and no coinsurance for up to two devices per year.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) provides partially covered vision services with no deductibles and no copays, though other eye exam services are not covered. Covered eye exams carry a 0% to 20% coinsurance (with routine exams limited to one per year), and eyewear is covered with no coinsurance up to a $300 annual limit.
Dental Services See details
Dental services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), featuring no copay and no coinsurance up to a $20,000 annual maximum for preventive and most comprehensive services, while Medicare-covered dental services require no copay and a 20% coinsurance. Maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics are not covered.
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 are required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin has 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) partially covers medical equipment, offering durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance. Prior authorization is required for these covered services, while diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required. Outpatient diagnostic procedures, lab services, and diagnostic radiological services carry no coinsurance, while therapeutic radiological services and outpatient X-rays require a 20% coinsurance.
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 some cardiac rehabilitation services with no copay and prior authorization, but 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
Skilled Nursing Facility (SNF) care is covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), including meal benefits and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. The plan provides up to $25 every three months for OTC items and offers a meal benefit for chronic or home-confining medical conditions.
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