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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 $3450.00 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) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order services charge copays ranging from $5 to $15 for Tier 1 and $10 to $30 for Tier 2, depending on the supply. For higher-tier medications, coverage costs are calculated as a percentage of the drug cost. Tier 3 preferred brand drugs require a 24% coinsurance across all pharmacy and mail-order channels. Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance, with specialty drugs limited to a one-month supply.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers comprehensive medical coverage with no copays or coinsurance for primary care visits, specialist consultations, and preventive care. For hospital stays, members pay a $190 daily copay for the first five days of inpatient care and no copay for outpatient visits, though outpatient hospital services may carry a coinsurance of up to 20%. Emergency care is accessible with a $150 copay, while urgent care services require a low $20 copay. This plan also features valuable everyday benefits, including comprehensive dental care with no copay up to a $3,000 annual limit and a $400 yearly allowance for vision eyewear. Additionally, members benefit from routine hearing exams with no copay, a $200 allowance every three months for over-the-counter items, and unlimited one-way rides to plan-approved medical locations. These robust dental, vision, and transportation coverages help ensure your essential health and wellness needs are met at minimal out-of-pocket costs.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) covers inpatient hospital services with no coinsurance, requiring a $190 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services with no copay, though coinsurance applies to several benefits. Outpatient hospital and ambulatory surgical center services require 0% to 20% coinsurance, outpatient substance abuse and observation services require 20% coinsurance, and outpatient blood services have no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HealthSpring TotalCare (HMO D-SNP) with a $175.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HealthSpring TotalCare (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 one-way rides to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $20 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent care, and emergency transportation are also covered with a $150 copay and no coinsurance, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care, specialist visits, occupational therapy, physical therapy, speech-language pathology, and telehealth services with no copay and no coinsurance. Opioid treatment program services are covered with no copay and 20% coinsurance, while podiatry, chiropractic, mental health, and psychiatric services are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and other screenings. Additional preventive services are partially covered with no copay and no coinsurance, offering fitness benefits and caregiver support, while sub-services like health education, weight management, and nutritional therapy are not covered.
Hearing Services See details
Hearing services covered by HealthSpring TotalCare (HMO D-SNP) include one annual routine exam and fitting with no copay, no coinsurance, and a required referral. Hearing aids are limited to two per year with no coinsurance and copays of $399 for OTC models and $399 to $1,800 for prescription models, though prescription hearing aids are only partially covered since inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, though other eye exam services are not covered. Covered benefits include one routine eye exam per year and a $400 annual allowance for eyewear, including contacts and one pair of glasses.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) offers comprehensive dental services with no copay and no coinsurance, covering preventive, restorative, and orthodontic care up to a $3,000 annual maximum. Prior authorization is required for Medicare-covered dental services, which are also available with no copay and no coinsurance.
Home Infusion bundled Services See details
HealthSpring TotalCare (HMO D-SNP) covers home infusion bundled services with no copay. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
HealthSpring TotalCare (HMO D-SNP) covers dialysis services with no copay and a 15% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under HealthSpring TotalCare (HMO D-SNP) are partially covered, offering lab services with no copay and no coinsurance, though prior authorization and referrals are required. Some services are covered, but diagnostic procedures and tests, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
HealthSpring TotalCare (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare (HMO D-SNP) covers some services under Cardiac Rehabilitation Services with no copay and no coinsurance, although a referral and prior authorization are required. However, 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 copayment for days 1 through 20 and a $218 copayment for days 21 through 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers other services, offering over-the-counter items up to $200 every three months and a limited-duration meal benefit for medical conditions with no copay and no coinsurance. Acupuncture is not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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