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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 South Mississippi. This plan received an overall rating of 4 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 generics and Tier 2 generics, you will pay no copay when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail order, Tier 1 copays range from $5 to $15, while Tier 2 copays range from $10 to $30 depending on the supply duration. Higher-tier medications require coinsurance across all pharmacy and mail-order options, regardless of whether you use standard or preferred services. Tier 3 preferred brand drugs carry a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. Additionally, Tier 5 specialty medications are limited to a one-month supply.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers comprehensive medical coverage, including inpatient hospital stays with no coinsurance and primary care visits with no copay and a 20% coinsurance. Urgent and emergency care are covered with flat copayments of $40 and $115, respectively, while most preventive care, home health services, and skilled nursing facility stays feature no copay and no coinsurance. Outpatient services, diagnostics, and durable medical equipment generally require no copay, though a 20% coinsurance and prior authorization often apply. This plan also provides valuable supplemental benefits, such as dental care with no copay or coinsurance up to a $4,000 annual limit, and eyewear covered up to $425 yearly with no copay or coinsurance. Routine hearing and vision exams require no copay and up to 20% coinsurance, while prescription hearing aids carry copays ranging from $399 to $1,800. Additionally, members enjoy unlimited free transportation to approved health locations, a $200 quarterly allowance for over-the-counter items, and home-delivered meals with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no coinsurance and Medicare-defined copayments, subject to prior authorization. This benefit is partially covered, as additional 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 prior authorization and coinsurance apply to several services. Outpatient hospital and ambulatory surgical center services require a 0% to 20% coinsurance, outpatient substance abuse sessions carry a 20% coinsurance, and outpatient blood services are 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. Prior authorization is required to access 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, requiring prior authorization. Transportation services are partially covered, offering unlimited rides to plan-approved health-related locations with no copay or coinsurance, while transportation to any other 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 featuring no coinsurance and a waived copay if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 plan maximum with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) covers primary care, specialist, therapy, telehealth, and opioid treatment services with no copay and 20% coinsurance (0% to 20% for telehealth). Podiatry is not covered, and while some psychiatric, chiropractic, and mental health services are covered, routine chiropractic care, other chiropractic services, and individual or group therapy sessions are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring TotalCare Plus (HMO D-SNP), with most services—including kidney disease education, diabetes training, and glaucoma screenings—requiring no copay and no coinsurance. The annual physical exam is covered with no copay and a 20% coinsurance, and additional preventive benefits are partially covered with no copay and no coinsurance, excluding services such as health education, nutritional therapy, and home safety assessments.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers hearing services, as inner ear, outer ear, and over the ear prescription hearing aids are not covered. Covered routine hearing exams have no copay and a 20% coinsurance, while OTC hearing aids require a $399 copay with no coinsurance, and eligible prescription hearing aids have a $399 to $1,800 copay with no coinsurance.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) vision services are partially covered, as other eye exam services are not covered. Covered routine eye exams have no copay and 0% to 20% coinsurance, while covered eyewear has no copay, no coinsurance, and a combined maximum benefit of $425 per year.
Dental Services See details
Dental services are covered by HealthSpring TotalCare Plus (HMO D-SNP), featuring no copay and no coinsurance for preventive and comprehensive care up to a $4,000 yearly maximum. Medicare-covered dental services are also covered with no copay and a 20% coinsurance, though prior authorization is required.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance. Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance, and prior authorization is required for these services.
Dialysis Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HealthSpring TotalCare Plus (HMO D-SNP) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance, though prior authorization is required. Diabetic equipment is only partially covered under this plan, as 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 required for all services. Diagnostic procedures require a copayment with no coinsurance, lab services have no copay, diagnostic radiological services feature no copay or coinsurance, and both therapeutic radiological and outpatient X-ray services require a 20% coinsurance with no copay.
Home Health Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay, although some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered under the $0 copay and instead 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 is partially covered because additional days beyond the Medicare-covered limit are not covered, though the plan does allow admission without a prior three-day inpatient hospital stay.
Other Services See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, though acupuncture is not covered. Eligible members receive up to $200 every three months for OTC items, as well as home-delivered meals for qualifying chronic illnesses or medical conditions.
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