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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 North Georgia. 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 $8.60. 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 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 service, while standard options require a $19 copay for a one-month supply. Tier 2 generic drugs generally carry a $20 copay for a one-month supply, though a three-month supply is available with no copay through preferred mail order. Tier 3 preferred brand-name drugs require a 23% coinsurance across all pharmacy and mail-order options. For Tier 4 non-preferred drugs and Tier 5 specialty medications, you will pay a 25% coinsurance. These details provide a clear picture of your potential out-of-pocket prescription costs with the HealthSpring TotalCare Plus (HMO D-SNP) plan.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays for inpatient hospital stays, outpatient blood services, and preventive care. For standard primary care, specialist visits, outpatient services, and dialysis, members generally pay no copay and a 20% coinsurance. Emergency care is available with a $115 copay, which is waived upon hospital admission, while urgent care visits require a $40 copay. This plan also includes valuable supplemental benefits, such as routine dental care up to a $3,300 yearly limit and eyewear up to a $425 annual maximum with no copay or coinsurance. Members can access hearing exams and prescription hearing aids with varying copays, alongside up to 40 one-way transportation trips per year with no copay and no coinsurance. Additionally, home health services, skilled nursing facility stays, and a quarterly $230 allowance for over-the-counter items are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers inpatient acute and psychiatric hospital care with no coinsurance and no plan copay, though Medicare-defined cost sharing and prior authorization are required. 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 copays, featuring a 0% to 20% coinsurance for outpatient hospital, ambulatory surgical, and substance abuse services. 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 no copay and a 20% coinsurance. Prior authorization is required to receive 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, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 40 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $50,000 lifetime maximum with a $115 copay and no coinsurance.
Primary Care See details
Primary Care benefits under HealthSpring TotalCare Plus (HMO D-SNP) are covered with no copay and a 20% coinsurance for primary care, specialist, and therapy services. Some chiropractic, mental health, and psychiatric services are covered with no copay and 0% to 20% coinsurance, though routine and other chiropractic care, individual and group therapy sessions, and podiatry services are not covered.
Preventive Services See details
HealthSpring TotalCare Plus (HMO D-SNP) provides partially covered preventive services, offering Medicare-covered preventive care, kidney disease education, and select screenings with no copay and no coinsurance. Annual physical exams are covered with no copay and a 20% coinsurance, and while fitness benefits and caregiver support are covered with no copay and no coinsurance, several supplemental services like health education, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers hearing exams with no copay and a 20% coinsurance for routine exams, as well as OTC hearing aids with a $399.00 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $399.00 to $1,800.00, though inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) offers vision services with no copay and 0% to 20% coinsurance for one routine eye exam per year, though other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance up to a $425 annual maximum for contacts, upgrades, or one pair of eyeglasses, lenses, and frames.
Dental Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Medicare-covered dental services with no copay and a 20% coinsurance, which require prior authorization. Other dental services, including exams, cleanings, restorative care, endodontics, periodontics, implants, and orthodontics, are covered with no copay and no coinsurance up to a $3,300 yearly maximum.
Home Infusion bundled Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment is partially covered under HealthSpring TotalCare Plus (HMO D-SNP), offering no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes and inserts. Prior authorization is required for these covered services, and diabetic supplies are not covered by this plan.
Diagnostic and Radiological Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers diagnostic and radiological services with prior authorization, featuring diagnostic procedures with a copay and no coinsurance, and lab services with no copay. Diagnostic radiological services require no copay or coinsurance, while therapeutic radiological services and outpatient X-rays carry a 20% coinsurance and no copay.
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
HealthSpring TotalCare Plus (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay, though prior authorization is required. While some services are covered, specific sub-services including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay 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 Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers other services, offering a home meal benefit and over-the-counter items with a $230 limit every three months at no copay and no coinsurance. Acupuncture is not covered under this plan.
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