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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 Arkansas. 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 $8.70. 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 $7400.00 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 offers an Enhanced Alternative drug benefit with an annual deductible of $615.00. For individuals who qualify for the low-income subsidy (LIS), the Part D premium is reduced to $8.70. During the initial coverage phase, you will pay a $20.00 copay for Tier 1 preferred generic drugs, 24% coinsurance for Tier 2 standard generics, and 25% coinsurance for Tier 3 preferred brands and Tier 4 non-preferred drugs. This initial coverage phase continues until your total drug costs reach $2,100.00. After your yearly out-of-pocket drug costs reach $2,100.00, you will enter the catastrophic coverage phase and pay nothing for covered Medicare Part D drugs.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers comprehensive medical coverage with no copays for primary care visits, routine physicals, and annual hearing exams. For inpatient hospital stays, beneficiaries pay a $187 daily copay for the first 10 days and no copay for days 11 through 90, while outpatient services feature no copays and coinsurance up to 20%. Emergency care is available with a $115 copay, and urgent care carries a $40 copay, both featuring no coinsurance. This plan also features robust supplemental benefits, including a $3,200 annual maximum for preventive and comprehensive dental care and a $500 yearly allowance for eyewear. Additionally, members benefit from a $160 quarterly over-the-counter allowance and up to 50 one-way trips annually to plan-approved locations. Note that some services, such as diabetic supplies and cardiac rehabilitation, are not covered under this plan.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) partially covers inpatient hospital services, with no coverage for additional days, non-Medicare-covered stays, or upgrades. Covered acute and psychiatric stays require prior authorization and have no coinsurance, with a copay of $187 per day for days 1 through 10 and no copay for days 11 through 90.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services with no copays and coinsurance ranging from 0% to 20% depending on the service. Covered benefits include outpatient hospital, ambulatory surgical center, and substance abuse services, most of which require prior authorization.
Partial Hospitalization See details
HealthSpring TotalCare (HMO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring TotalCare (HMO D-SNP), though transportation is only partially covered because trips to any health-related location are not covered. Ground and air ambulance services require a 20% coinsurance and no copay, and the plan covers up to 50 one-way trips per year to plan-approved health-related locations.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum coverage limit with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care physician services with no copay or coinsurance, and telehealth services with a 0% to 20% coinsurance and no copay. Specialist, occupational, physical therapy, and opioid treatment services require a 20% coinsurance and no copay, while chiropractic care is partially covered (excluding routine care), and podiatry, 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 or coinsurance for Medicare-covered zero-dollar services, annual physical exams, and kidney disease education. Additional preventive benefits are partially covered, offering fitness programs and caregiver support, while sub-services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring TotalCare (HMO D-SNP) covers annual routine hearing exams and fitting evaluations with no copay, coinsurance, or deductible. Prescription hearing aids are partially covered with a copay of $399 to $1,800 and no coinsurance—excluding inner ear, outer ear, and over the ear types—while OTC hearing aids are covered with a $399 copay and no coinsurance.
Vision Services See details
Vision services are covered by HealthSpring TotalCare (HMO D-SNP) with no deductible, which includes one routine eye exam every year. Beneficiaries also receive a $500 annual maximum coverage limit for eyewear, including contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) covers Medicare-covered dental services with a 20% coinsurance and no copay. The plan also covers a wide range of preventive and comprehensive dental services, including cleanings, x-rays, and restorative treatments, up to a $3,200 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring TotalCare (HMO D-SNP) with prior authorization, requiring no copay and 0% to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are also covered under this benefit with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HealthSpring TotalCare (HMO D-SNP) with a 20% coinsurance and no copay. Prior authorization is required for this benefit.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) partially covers medical equipment with a 20% coinsurance and no copay for covered items like durable medical equipment, prosthetics, and diabetic therapeutic shoes. However, diabetic supplies are not covered under this plan, and prior authorization is required for covered services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring TotalCare (HMO D-SNP) with prior authorization, featuring a copay and up to 20% coinsurance for diagnostic tests, and no copay for lab services. Radiological and outpatient X-ray services require no copayments and carry coinsurance up to 20%.
Home Health Services See details
Home Health Services are covered by HealthSpring TotalCare (HMO D-SNP) subject to prior authorization. Specific copay and coinsurance information for these services is not specified in the plan benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring TotalCare (HMO D-SNP) plan, which means there is no copay or coinsurance. All associated sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services, are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay or coinsurance for days 1 to 20, and a $218 daily copay with no coinsurance for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not needed, the benefit is only partially covered as additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) provides partial coverage for Other Services, featuring a $160 quarterly over-the-counter allowance and limited-duration meal benefits for chronic illnesses, though specific copay and coinsurance information is not provided. Acupuncture and highly integrated dual-eligible SNP services are not covered under this benefit.
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