A non-government entity
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 North Georgia. 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 $24.30. 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 $5900.00 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:
Sign up for HealthSpring TotalCare (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HealthSpring TotalCare (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay when using a preferred pharmacy or preferred mail order service, while standard pharmacies charge a $19 copay for a one-month supply. Tier 2 generic drugs generally require a $20 copay for a one-month supply, but you can get a three-month supply with no copay through preferred mail order. Higher tier medications under this plan transition from copays to coinsurance during the initial coverage phase. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both carry a 25% coinsurance across all pharmacy and mail order options. Specialty medications are limited to a one-month supply.
Additional Benefits
HealthSpring TotalCare (HMO D-SNP) offers robust coverage with no copays and no coinsurance for primary care, specialist visits, preventive care, and comprehensive dental services up to a $2,350 annual limit. For hospital care, inpatient stays require a $280 copay for the first six days followed by no copay, while outpatient services are available with no copays and coinsurance up to 20%. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Routine vision and hearing exams are covered with no copays, and members receive a $300 annual allowance for eyewear and affordable copays for prescription hearing aids. The plan also features no copays or coinsurance for home health care, up to 30 free one-way transportation trips annually, and a $175 quarterly allowance for over-the-counter items and meals. Skilled nursing care is covered with no copay for the first 20 days and a $218 copay for days 21 through 100.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required and additional days, upgrades, and non-Medicare-covered stays are excluded. Acute stays require a $280 copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require a $1,850 copay per admission.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services with no copays, though coinsurance ranging from 0% to 20% applies to 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 (HMO D-SNP) covers partial hospitalization services with a $140 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring TotalCare (HMO D-SNP), with prior authorization required. Ground ambulance services require a $200 copay and coinsurance, air ambulance services require a 20% coinsurance and a copay, and transportation services are partially covered, offering up to 30 one-way trips per year to plan-approved locations with no copay and no coinsurance (transportation to any health-related location is not covered).
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care, specialist, therapy, and telehealth services with no copay and no coinsurance, while opioid treatment is covered with no copay and 20% coinsurance. Podiatry is not covered, and although some chiropractic, mental health, and psychiatric services are covered, routine or other chiropractic care and individual or group therapy sessions are not.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) covers preventive services like annual physical exams and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered, including fitness and caregiver support, while sub-services such as health education, weight management, nutritional benefits, and in-home support are not covered.
Hearing Services See details
Hearing Services are covered by HealthSpring TotalCare (HMO D-SNP), offering annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $399 to $1,800 for up to two devices yearly (inner ear, outer ear, and over-the-ear models are not covered), while up to two OTC hearing aids are covered per year with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare (HMO D-SNP) offers partially covered vision services with no deductibles, excluding other eye exam services but covering one routine eye exam annually with no copay and 0% to 20% coinsurance. Eyewear is covered with no copay, no coinsurance, and a $300 annual maximum benefit for contact lenses, upgrades, or one pair of eyeglasses per year.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) covers a wide range of preventive and comprehensive dental services, including exams, cleanings, and orthodontics, with no copay and no coinsurance. These benefits are subject to an annual maximum coverage limit of $2,350, and prior authorization is required for Medicare-covered dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy and other drugs require no copay with coinsurance ranging from no coinsurance up to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
HealthSpring TotalCare (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HealthSpring TotalCare (HMO D-SNP) with no copay and 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered, as diabetic therapeutic shoes and inserts are covered while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HealthSpring TotalCare (HMO D-SNP) with prior authorization required. Lab and radiological services require no copay, diagnostic procedures require a copayment with no coinsurance, and a 20% coinsurance applies to therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the HealthSpring TotalCare (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring TotalCare (HMO D-SNP) plan, as all related sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a 3-day inpatient hospital stay is not required prior to admission, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other Services are partially covered by HealthSpring TotalCare (HMO D-SNP), featuring over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. Under this benefit, members receive up to a $175 allowance every three months for OTC items and covered meals for qualifying medical conditions.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved