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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 Arkansas. 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 $2.00. 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 enhanced alternative drug benefit with an annual prescription drug deductible of $615.00. Under this plan, Tier 1 preferred generic drugs require a $20.00 copay, while Tier 2 standard generics require a 23% coinsurance. Tier 3 preferred brands and Tier 4 non-preferred drugs both carry a 25% coinsurance across all pharmacy and mail-order options. For individuals who qualify for the low-income subsidy, costs can be reduced to $2.00. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase where you will pay nothing for covered Part D prescriptions. This structure helps manage your medication expenses effectively throughout the plan year.
Additional Benefits
HealthSpring TotalCare Plus (HMO D-SNP) offers many essential medical services with no copay, though members typically pay a 20% coinsurance for primary care, outpatient services, diagnostics, and medical equipment. Emergency care requires a $115 copay, which is waived if you are admitted, while urgently needed services have a $40 copay. Inpatient hospital stays and skilled nursing facility care are subject to Medicare-defined copays and coinsurance. For extra benefits, the plan provides robust dental coverage with no copay or coinsurance up to a $3,500 annual limit, alongside a $500 yearly eyewear allowance. Members also benefit from a $160 quarterly over-the-counter allowance and up to 50 one-way transportation trips to plan-approved locations. Routine hearing exams feature no copay and a 20% coinsurance, while covered hearing aids require copays ranging from $399 to $1,800.
Inpatient Hospital See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers inpatient acute and psychiatric hospital services, requiring prior authorization and charging the Medicare-defined copays and coinsurance per stay. There is no cost sharing on the day of discharge, but 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 copay, with coinsurance ranging from no coinsurance up to 20% depending on the service. Covered benefits include outpatient hospital, observation, ambulatory surgical center, substance abuse, and blood services, most of which require prior authorization.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring TotalCare Plus (HMO D-SNP) with a 20% coinsurance and no copay. Prior authorization is required for these services.
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, subject to prior authorization. Transportation services are partially covered, providing up to 50 one-way trips per year to plan-approved health-related locations, while trips to any health-related location are 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 limit with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) provides partially covered primary care benefits with no copays and a 20% coinsurance, which ranges from no coinsurance to 20% for telehealth. Podiatry, routine chiropractic care, mental health specialty services, and psychiatric services are not covered, and prior authorization is required for most other services.
Preventive Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers preventive services with no copay and no coinsurance for zero-dollar services, while an annual physical exam requires a 20% coinsurance and no copay. Additional preventive benefits are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, massage, adult day health, nutritional benefits, palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, bathroom safety, and counseling.
Hearing Services See details
Hearing services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), excluding inner ear, outer ear, and over-the-ear prescription hearing aids. Routine exams and fittings are covered with a 20% coinsurance and no copay, while covered OTC and prescription hearing aids require a copay ranging from $399 to $1,800 and no coinsurance.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers one routine eye exam every year with no copay and 0% to 20% coinsurance. Additionally, members receive a $500 annual allowance for eyewear, including contact lenses, eyeglasses, frames, and upgrades, with no deductible.
Dental Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Medicare dental services with a 20% coinsurance and no copay. Other dental and orthodontic services are covered with no copay or coinsurance, up to a maximum annual benefit of $3,500.
Home Infusion bundled Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers home infusion bundled services with prior authorization and step therapy requirements. Covered Part B chemotherapy, radiation, and other drugs feature no copay and 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 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
HealthSpring TotalCare Plus (HMO D-SNP) covers medical equipment with no copay and a 20% coinsurance, subject to prior authorization. This benefit is partially covered, providing coverage for durable medical equipment, prosthetics, and diabetic therapeutic shoes, while 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. Members pay no copay for lab services, while diagnostic procedures and radiological services, including X-rays, feature coinsurance ranging from 0% to 20% and no copay for radiological services.
Home Health Services See details
Home health services are covered under the HealthSpring TotalCare Plus (HMO D-SNP) plan, though prior authorization is required. Specific copay and coinsurance details for these services are not specified in the plan benefits.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare Plus (HMO D-SNP) does not cover Cardiac Rehabilitation Services, as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage. Consequently, there are no copay or coinsurance benefits available, and members are responsible for the full cost of these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by HealthSpring TotalCare Plus (HMO D-SNP) under Medicare-defined copays and coinsurance, but additional days beyond Medicare-covered SNF are not covered. Prior authorization is required, though a prior three-day inpatient hospital stay is not required before admission.
Other Services See details
HealthSpring TotalCare Plus (HMO D-SNP) offers partial coverage for other services, providing a meal benefit for qualifying conditions and a $160 quarterly over-the-counter allowance with no copay or coinsurance. Acupuncture and dual eligible SNPs with highly integrated services are not covered under this plan.
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