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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 Texas. 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 $3400.00 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) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using preferred pharmacies or preferred mail-order services. If you choose standard pharmacies or standard mail order, Tier 1 drugs carry a copay starting at $5 and Tier 2 drugs start at $10 for a one-month supply. Higher-tier medications require coinsurance rather than set copays, with Tier 3 preferred brand drugs requiring a 24% coinsurance across all pharmacy options. Non-preferred drugs in Tier 4 and specialty drugs in Tier 5 both require a 25% coinsurance for your prescriptions. These coinsurance rates apply regardless of whether you use preferred or standard pharmacies, or mail-order services.
Additional Benefits
HealthSpring TotalCare (HMO D-SNP) offers robust coverage with no copay and no coinsurance for primary care, specialist visits, outpatient hospital services, and unlimited acute inpatient hospital stays. Emergency care requires a $150 copay, while ground ambulance services feature a $100 copay, and urgent care is available with no copay. Specialized treatments like dialysis and Part B drugs generally carry a 20% coinsurance, while skilled nursing facilities require daily copays starting at $20 for the first 20 days. The plan provides valuable extra benefits, including dental care with no copay up to a $3,000 annual limit, and routine vision exams and eyewear with no copay up to a $275 yearly maximum. Hearing exams feature no copay, though prescription hearing aids require copays ranging from $399 to $1,800. Members also benefit from unlimited one-way transportation to plan-approved locations, home health services with no copay, and a $200 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care under HealthSpring TotalCare (HMO D-SNP) is covered with no coinsurance, offering no copay for unlimited acute stays, though upgrades and non-Medicare-covered stays are not covered. Psychiatric stays also feature no coinsurance, but require a $100 copay for days 1 through 6 and no copay for days 7 through 90, with additional days and non-Medicare-covered stays not covered.
Outpatient Services See details
Outpatient services are covered by HealthSpring TotalCare (HMO D-SNP) with no copays and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. Outpatient substance abuse services also feature no copay, but require a 20% coinsurance for individual and group sessions.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring TotalCare (HMO D-SNP) with a $175.00 copay and no coinsurance, though prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring TotalCare (HMO D-SNP), with ground ambulance services requiring a $100 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered, offering unlimited one-way rides to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
Primary care, specialist, therapy, and telehealth services are covered under HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance. Opioid treatment is covered with no copay and 20% coinsurance, while podiatry is not covered. Some services are covered for chiropractic, mental health, and psychiatric care, but routine chiropractic, other chiropractic, and individual or group sessions are not covered.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) offers preventive services with no copay and no coinsurance, though the benefit is only partially covered. Uncovered sub-services include health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by HealthSpring TotalCare (HMO D-SNP), offering routine exams and fitting evaluations with no copay, no coinsurance, and no deductible. Up to two prescription hearing aids are covered per year with no coinsurance and copays ranging from $399 to $1,800, though inner ear, outer ear, and over-the-ear models are not covered. OTC hearing aids are also covered up to two per year with a $399 copay and no coinsurance.
Vision Services See details
Vision Services are partially covered by HealthSpring TotalCare (HMO D-SNP), offering no copay, no coinsurance, and no deductible for routine eye exams and eyewear, though other eye exam services are not covered. The plan covers one routine eye exam per year and provides a $275 annual maximum benefit for eyewear, including contact lenses and one pair of eyeglasses.
Dental Services See details
Dental services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance for preventive and comprehensive care, including cleanings, x-rays, and implants, up to a maximum benefit of $3,000 per year. Medicare-covered dental services also have no copay and no coinsurance, though prior authorization is required.
Home Infusion bundled Services See details
HealthSpring TotalCare (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this benefit.
Medical Equipment See details
Medical equipment is partially covered under HealthSpring TotalCare (HMO D-SNP), offering durable medical equipment and diabetic equipment with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered. Covered prosthetic devices and medical supplies require no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers diagnostic services, offering lab services with no copay and no coinsurance, while other diagnostic procedures and tests are not covered. For radiological services, some services are covered but diagnostic radiological, therapeutic radiological, and outpatient X-ray services are not covered in practice, and all covered services require prior authorization and referrals.
Home Health Services See details
Home Health Services are fully covered under the HealthSpring TotalCare (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, though prior authorization and a referral are required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 copay per day for days 1 through 20 and a $218 copay per day for days 21 through 100. 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) provides coverage for select other services with no copay and no coinsurance, including a meal benefit for qualifying medical conditions and a $200 quarterly over-the-counter items allowance. Acupuncture is not covered under this plan.
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