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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 Pennsylvania. 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay when using a preferred pharmacy or preferred mail-order service, compared to a $17 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs cost as low as an $8 copay for a one-month supply, or no copay for a three-month supply when using preferred mail order. Brand-name and specialty medications are subject to coinsurance rather than flat copayments under this plan. Tier 3 preferred brand drugs require a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require 25% coinsurance. Utilizing preferred network pharmacies and mail-order options is the most cost-effective way to fill your prescriptions under this plan.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) Medicare plan offers comprehensive medical coverage featuring no copay for inpatient hospital stays, skilled nursing facility care, and primary care visits. Most outpatient services, specialist visits, and diagnostic tests require no copay, though patients may pay a coinsurance ranging from 0% to 20%. Emergency care is accessible with a $115 copay, which is waived upon hospital admission, while urgent care visits require a $40 copay. This plan also provides robust supplemental benefits, including preventive and comprehensive dental care with no copay or coinsurance up to $2,600 annually. Members benefit from no copay on routine eye exams, a $500 annual eyewear allowance, and unlimited transportation to plan-approved health locations. Additionally, the plan includes a $300 quarterly over-the-counter allowance and home health services with no copay or coinsurance.
Inpatient Hospital See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services with no copay and no coinsurance, although prior authorization is required. However, additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
Outpatient services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copays, though prior authorization is required for most services. Patients will pay a 0% to 20% coinsurance for outpatient hospital and ambulatory surgical center services, a 20% coinsurance for outpatient substance abuse services, and no coinsurance or deductible for outpatient blood services.
Partial Hospitalization See details
HealthSpring TotalCare Plus (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring TotalCare Plus (HMO D-SNP), with ground and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering unlimited rides 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
Emergency services are covered by HealthSpring TotalCare Plus (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 Plus (HMO D-SNP) covers primary care, specialist, mental health, and therapy services with no copay and 20% coinsurance, though prior authorization is required for most specialist care. Telehealth services are available with no copay and 0% to 20% coinsurance, while chiropractic and podiatry 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 most services, though the annual physical exam requires no copay and a 20% coinsurance. Additional benefits are partially covered, including fitness programs and home safety devices with no copay and no coinsurance, while services such as health education, personal emergency response systems, in-home support, and weight management are not covered.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) offers partially covered hearing services, including exams with no copay but a 20% coinsurance for routine visits. Prescription hearing aids have no coinsurance with copays ranging from $399 to $1,800, though inner, outer, and over-the-ear types are not covered, while over-the-counter hearing aids are covered with a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), as other eye exam services are not covered. Covered routine eye exams are limited to one per year with no copay and 0% to 20% coinsurance, while covered eyewear has no copay, no coinsurance, and a $500 annual maximum for contact lenses, upgrades, or one pair of eyeglasses.
Dental Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers preventive and comprehensive dental services with no copay and no coinsurance up to a maximum plan benefit of $2,600 per year. Medicare-covered dental services are also available with no copay and a 20% coinsurance.
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 is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin carries a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
The HealthSpring TotalCare Plus (HMO D-SNP) plan covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is partially covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and a 20% coinsurance, and prior authorization is required. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, 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 and no copays. There is no coinsurance for diagnostic procedures, tests, lab services, and diagnostic radiological services, 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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HealthSpring TotalCare Plus (HMO D-SNP) with no copay and prior authorization, though only some services are covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require 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, although prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), featuring a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $300 every three months for health-related items, and the meal benefit is available for chronic illnesses or home-recovery conditions.
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