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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 South Mississippi. This plan received an overall rating of 4 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 $6750.00 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 (HMO D-SNP) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, there is no copay when using a preferred pharmacy or preferred mail order service. If you use a standard pharmacy or standard mail order, Tier 1 copays range from $5 to $15, while Tier 2 copays range from $11 to $33 depending on the supply duration. For higher-tier medications, cost-sharing transitions to coinsurance across all pharmacy and mail order options. Tier 3 preferred brand drugs require a 24% coinsurance for all supply lengths. Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance, with Tier 5 coverage limited to a one-month supply.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers robust medical coverage, featuring no copays and no coinsurance for primary care, specialist visits, telehealth, and preventive care. For hospital stays, members pay a $195 daily copay for the first six days of acute inpatient care, while outpatient services require no copay with coinsurance up to 20%. Emergency room visits carry a $130 copay, and unlimited transportation to approved locations is provided with no copay or coinsurance. In addition to core medical care, this plan provides comprehensive dental coverage with no copay or coinsurance up to a $3,000 annual maximum. Members also benefit from routine vision and hearing exams with no copays, a $375 annual eyewear allowance, and $210 every three months for over-the-counter items. Home health services are also fully covered with no copay and no coinsurance, ensuring affordable care at home.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $195 daily copay for days 1 to 6 (and no copay for days 7 to 90) for acute stays, alongside a $1,850 copay per psychiatric stay. Additional hospital days, non-Medicare-covered stays, and acute upgrades are not covered under this plan.
Outpatient Services See details
Outpatient services are covered under the HealthSpring TotalCare (HMO D-SNP) plan with no copays, though coinsurance ranges from 0% to 20% depending on the specific service. Prior authorization is required for most outpatient hospital, ambulatory surgical center, and substance abuse services, 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 a $140.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HealthSpring TotalCare (HMO D-SNP) covers ground ambulance services with a $245 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for unlimited one-way trips to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $130 copay and urgently needed services with a $50 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 up to a $50,000 maximum benefit with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care, specialist visits, telehealth, therapy, and other healthcare professional services with no copay and no coinsurance. Opioid treatment program services are covered with no copay and a 20% coinsurance, while chiropractic and podiatry services are not covered. Some mental health and psychiatric services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered care, including annual physical exams, fitness benefits, caregiver support, and kidney education. However, several additional services, such as health education, nutritional benefits, weight management, alternative therapies, and in-home support, are not covered.
Hearing Services See details
HealthSpring TotalCare (HMO D-SNP) covers annual routine hearing exams and fittings with no copay and no coinsurance. Hearing aids are partially covered for up to two devices per year, with OTC models requiring a $399.00 copay and no coinsurance, and prescription models requiring a $399.00 to $1,800.00 copay and no coinsurance; however, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by HealthSpring TotalCare (HMO D-SNP) with no copay, no coinsurance, and no deductible for covered services. This benefit includes one routine eye exam and up to $375 per year for eyewear, though other eye exam services are not covered.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) covers comprehensive dental services with no copay and no coinsurance, up to a maximum annual benefit of $3,000. This includes preventive care, exams, cleanings, restorative services, implants, and orthodontics, though prior authorization is required for Medicare-covered dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and a 0% to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under HealthSpring TotalCare (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) covers medical equipment with no copay and a 20% coinsurance, subject to prior authorization. This benefit is partially covered, as durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring TotalCare (HMO D-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and tests require a copay with no coinsurance, lab services have no copay but require coinsurance, and therapeutic radiology requires a 20% coinsurance with no copay. Outpatient X-rays and diagnostic radiology are covered with no copays or coinsurance.
Home Health Services See details
Home Health Services are covered under HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring TotalCare (HMO D-SNP) plan, as all related sub-services, including intensive cardiac and pulmonary rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring TotalCare (HMO D-SNP) with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100 per stay. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The plan provides up to $210 every three months for OTC items and covers meals for members managing chronic illnesses or medical conditions at home.
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