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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 North Florida. This plan received an overall rating of 3.5 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 $4.80. 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 $5950.00 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) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail-order services, compared to a $19 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs require a $20 copay for a one-month supply at most locations, but you pay no copay for a three-month supply when using preferred mail-order. For brand-name and specialty medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance across all pharmacy options. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers robust medical coverage with no copays or coinsurance for preventive care, primary care, and specialist visits. For hospital care, inpatient acute stays require a $199 daily copay for the first five days, while outpatient services carry copays up to $195 with no coinsurance. Emergency care is available with a $130 copay, which is waived upon admission, and ground ambulance services require a $190 copay. Beyond standard medical care, this plan provides extensive supplemental benefits, including comprehensive dental and vision services with no copays and generous allowances. Members receive a $2,400 annual dental limit, a $275 yearly eyewear allowance, and a $140 quarterly credit for over-the-counter items. Additionally, the plan covers up to 40 free one-way trips to plan-approved locations and routine hearing exams with no copay.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $199 daily copay for days 1 through 5 (with no copay for days 6 through 90) and psychiatric stays incur an $1,850 copay per stay, while additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient hospital and observation services with copays ranging from $0 to $195 and no coinsurance. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse services require no copay and a 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring TotalCare (HMO D-SNP) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring TotalCare (HMO D-SNP) covers ground ambulance services with a $190 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 40 one-way trips per year to plan-approved locations, though 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, and urgently needed services with a $50 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 lifetime maximum benefit with a $130 copay and no coinsurance per service.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care, specialist, telehealth, and therapy services with no copay and no coinsurance, whereas opioid treatment has no copay and a 20% coinsurance. Podiatry is not covered, and while some chiropractic, mental health, and psychiatric services are covered, their sub-services—including routine chiropractic care and individual or group sessions—are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, and various screenings. Additional preventive services are partially covered, offering physical and memory fitness benefits with no copay and no coinsurance, but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
HealthSpring TotalCare (HMO D-SNP) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered for up to two devices per year with no coinsurance and a copay of $399 to $1800, excluding inner ear, outer ear, and over-the-ear models, while up to two OTC hearing aids are covered with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers vision services with no copay, no coinsurance, and no deductible, offering one routine eye exam per year and a $275 annual maximum allowance for eyewear such as contacts, lenses, and frames. While routine exams and eyewear are covered, other eye exam services are not covered under this plan.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) covers preventive and comprehensive dental services with no copay and no coinsurance, up to a maximum benefit of $2,400 per year. Covered services include exams, cleanings, x-rays, implants, and orthodontics, though 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, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring TotalCare (HMO D-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) provides partial coverage for medical equipment with no copay and a 20% coinsurance, though prior authorization is required. Covered items include durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring TotalCare (HMO D-SNP) covers diagnostic and radiological services, requiring prior authorization for all services. Diagnostic procedures require a copay with no coinsurance, lab services have no copay but require coinsurance, and radiological services feature no copays, with a 20% coinsurance for therapeutic radiology and no coinsurance for diagnostic radiology and outpatient X-rays.
Home Health Services See details
Home health services are 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 under HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required. While some services are covered, 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 $10.00 daily copay for days 1 through 20 and a $218.00 daily copay for days 21 through 100. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HealthSpring TotalCare (HMO D-SNP), excluding acupuncture but offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Covered members receive up to a $140 maximum benefit every three months for OTC items, as well as qualifying meal benefits for chronic illnesses or medical conditions.
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