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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 Tennessee. 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 has an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order, compared to a $19 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs generally require a $20 copay for a one-month supply, but you can secure a three-month supply with no copay through preferred mail order. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance. These coinsurance rates remain the same across preferred, standard, and mail-order pharmacy options.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers comprehensive medical coverage with many essential services featuring no copays. Members pay no copay and no coinsurance for inpatient hospital stays, skilled nursing facility care, and home health services. For routine outpatient medical visits, including primary care and specialist consultations, there is no copay, though a 20% coinsurance typically applies. The plan also includes robust dental, vision, and hearing benefits, highlighted by up to $4,000 in dental services and a $500 annual eyewear allowance with no copay or coinsurance. Additionally, members can access up to 50 free one-way trips per year for medical transportation and receive a $225 quarterly allowance for over-the-counter items with no copay. Emergency room visits carry a $110 copay, while urgent care services require a $40 copay, with no coinsurance for either.
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. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay, though coinsurance ranges from 0% to 20% depending on the specific service. Outpatient hospital, ambulatory surgical center, and outpatient substance abuse services require prior authorization and carry a 0% to 20% coinsurance, while outpatient blood services are covered with no copay, coinsurance, or 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 access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the HealthSpring TotalCare Plus (HMO D-SNP) plan, featuring a 20% coinsurance and no copay for ground and air ambulance rides. Additionally, the plan offers up to 50 one-way trips per year to plan-approved health-related locations with no copay or 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 $110 copay and urgently needed services with a $40 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $110 copay and no coinsurance, subject to a $50,000 maximum plan benefit limit.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) offers primary care, specialist, therapy, and opioid treatment services with no copay and 20% coinsurance, and telehealth with no copay and 0% to 20% coinsurance. Podiatry is not covered, and while some chiropractic services (no copay, 20% coinsurance) and mental health and psychiatric services (no copay, no coinsurance) are covered, routine and other chiropractic care and individual and group sessions are not covered.
Preventive Services See details
Preventive services under HealthSpring TotalCare Plus (HMO D-SNP) are generally covered with no copay and no coinsurance, although an annual physical exam requires a 20% coinsurance with no copay. This benefit is partially covered, offering fitness benefits and caregiver support, but excluding services such as health education, weight management, and in-home safety assessments.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers annual hearing exams with no copay and 20% coinsurance, as well as fitting evaluations with no deductible. Prescription hearing aids are partially covered with a $399 to $1,800 copay and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. Up to two over-the-counter (OTC) hearing aids are also covered each year with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) provides partially covered vision services with no deductibles, featuring one routine eye exam per year with no copay and 0% to 20% coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts and one pair of glasses per year, has no copay or coinsurance up to a $500 annual maximum.
Dental Services See details
Dental services are covered by HealthSpring TotalCare Plus (HMO D-SNP), which offers Medicare-covered dental care with no copay and 20% coinsurance, plus other dental services with no copay and no coinsurance up to a $4,000 annual maximum. This comprehensive coverage includes unlimited diagnostic, preventive, restorative, endodontic, periodontic, prosthodontic, oral surgery, implant, and orthodontic services.
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. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and 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) partially covers medical equipment with no copay and a 20% coinsurance, requiring prior authorization for covered items. This includes coverage for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though 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. Diagnostic procedures require a copay and no coinsurance, while diagnostic radiological services have no copay and no coinsurance. Lab services feature no copay but require coinsurance, and both therapeutic radiology and outpatient X-ray services require no copay and a 20% minimum 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 by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and require prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for PAD are not covered in practice 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 copayment and no coinsurance, though prior authorization is required. While the plan allows for SNF admission without a prior three-day inpatient hospital stay, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare Plus (HMO D-SNP) provides partially covered other services, which include over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. Members receive up to $225 every three months for OTC items, alongside a meal benefit for chronic illnesses or medical conditions requiring them to remain at home.
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