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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 Connecticut. This plan received an overall rating of 2.5 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 $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 prescription 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 options charge a $5 copay for a one-month supply. Tier 2 generic drugs start at a $7 copay for a one-month supply at preferred locations, and members pay no copay for a three-month supply when using preferred mail order. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 23% coinsurance across all pharmacy and mail order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with specialty prescriptions limited to a one-month supply.
Additional Benefits
HealthSpring TotalCare Plus (HMO D-SNP) offers robust health coverage with no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. For outpatient services, primary and specialist care, and durable medical equipment, members will generally pay no copay but are responsible for a 20% coinsurance. Diagnostic lab work and preventative care are also fully covered with no copay and no coinsurance, helping you manage your health affordably. Additional benefits include preventive dental, routine vision exams, and up to 24 one-way transportation trips per year with no copay and no coinsurance. Hearing aid benefits are covered with copays ranging from $399 to $1,800, while emergency and urgent care services require flat copays of $115 and $40 with no coinsurance. Members also receive a quarterly allowance of $45 for over-the-counter items and a meal benefit with no copay or coinsurance.
Inpatient Hospital See details
HealthSpring TotalCare Plus (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, although prior authorization is required. However, 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, though coinsurance of up to 20% and prior authorization are required for outpatient hospital, observation, ambulatory surgical center, and substance abuse services. Outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
HealthSpring TotalCare Plus (HMO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring TotalCare Plus (HMO D-SNP), featuring a 20% coinsurance and no copay for ground and air ambulance services. Transportation benefits are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, 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 urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance, up to a $50,000 maximum plan benefit limit.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) covers primary care, specialist, occupational/physical/speech therapy, and opioid treatment services with no copay and 20% coinsurance, while telehealth benefits feature no copay and 0% to 20% coinsurance. Routine podiatry is covered for up to 6 visits per year with no copay and 20% coinsurance, but chiropractic, mental health specialty, and psychiatric services are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance for Medicare-covered preventive services, kidney disease education, and screenings. The annual physical exam is covered with no copay and 20% coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, including fitness benefits and caregiver support, while sub-services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) offers partially covered hearing services, including one routine hearing exam per year with no copay and 20% coinsurance, and one fitting evaluation with no copay or coinsurance. Up to two prescription hearing aids per year are 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 up to two OTC hearing aids are covered with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers vision services with no copay and 0% to 20% coinsurance for routine eye exams, though other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance up to a $175 annual maximum.
Dental Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Medicare-allowed dental services with no copay and a 20% coinsurance, while preventive and comprehensive dental services are covered with no copay and no coinsurance up to a $750 annual maximum.
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, covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring TotalCare Plus (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, offering diabetic therapeutic shoes and inserts with no copay and 20% coinsurance, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with prior authorization required. Outpatient diagnostic procedures, lab services, and diagnostic radiological services have no copay and no coinsurance, while therapeutic radiological services and outpatient X-rays have no copay and a 20% coinsurance.
Home Health Services See details
Home health services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers cardiac rehabilitation services with no copay and prior authorization, but only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and are subject to 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, and does not require a prior three-day inpatient hospital stay. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers other services with no copay and no coinsurance, which includes a meal benefit and up to $45 every three months for over-the-counter (OTC) items. Acupuncture is not covered under this benefit.
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