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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 Orlando. This plan received an overall rating of 3.5 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 $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 $1500.00 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 has an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail-order service, compared to a $19 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs generally require a $20 copay for a one-month supply, but you can secure a three-month supply with no copay through preferred mail order. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copayments. You will pay a 23% coinsurance for Tier 3 preferred brand drugs, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance across all pharmacy and mail-order delivery options.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for many essential services, including inpatient hospital stays, primary and specialist care, emergency services, and home health care. Additionally, members can access skilled nursing facility care for up to 100 days, dialysis, and lab services at no cost. However, some services like air ambulance transportation and Medicare Part B drugs may require up to a 20% coinsurance, while worldwide emergency care incurs a $135 copay. For everyday wellness, the plan features dental coverage up to a $2,500 annual limit and vision services with a $300 yearly eyewear allowance, both with no copays or coinsurance. Routine hearing exams are also covered at no cost, though prescription hearing aids require copays ranging from $399 to $1,800. Members also benefit from a quarterly over-the-counter allowance of $165 and qualifying meal benefits with no copay.
Inpatient Hospital See details
HealthSpring TotalCare Plus (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. Outpatient substance abuse services are not covered in practice, as both individual and group sessions are excluded from coverage.
Partial Hospitalization See details
Partial hospitalization services are covered under the HealthSpring TotalCare Plus (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), requiring prior authorization. Air ambulance services are covered with a 20% coinsurance and no copay, while ground ambulance is not covered; unlimited one-way transportation to plan-approved locations features no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers emergency and urgently needed services with no copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and a $135 copay per service, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) covers primary care, specialist, therapy, telehealth, and opioid treatment services with no copay and no coinsurance, while podiatry is not covered. Some chiropractic, mental health, and psychiatric services are covered, but routine and other chiropractic care, along with individual and group sessions for mental health and psychiatric services, are not covered.
Preventive Services See details
Preventive services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance for covered options such as annual physical exams, kidney disease education, and fitness benefits. However, numerous additional preventive services are not covered, including health education, in-home safety assessments, personal emergency response systems (PERS), and nutritional benefits.
Hearing Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers annual hearing exams and fittings with no deductible, no copay, and no coinsurance, subject to a referral. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399.00 to $1,800.00 for up to two devices per year, excluding inner ear, outer ear, and over the ear models. Up to two OTC hearing aids are also covered annually with a $399.00 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) vision services are partially covered with no copay and no coinsurance, though other eye exam services are not covered. The plan features one routine eye exam per year and a $300 annual maximum allowance for eyewear, which covers contact lenses, upgrades, and one pair of eyeglasses.
Dental Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers dental services with no copay and no coinsurance, up to a maximum annual benefit of $2,500. This includes unlimited preventive, diagnostic, and restorative care, as well as specialized treatments like endodontics, periodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance, though 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 drugs requiring a copay of up to $35.
Dialysis Services See details
Dialysis services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
HealthSpring TotalCare Plus (HMO D-SNP) covers durable medical equipment with no copay and no coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes are not covered, and while some non-Medicare prosthetics and medical supplies are covered, prosthetic devices and medical supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), which features lab services with no copay and no coinsurance, subject to referral and prior authorization. Other diagnostic procedures and tests, as well as all radiological services—including diagnostic, therapeutic, and outpatient X-ray services—are not covered.
Home Health Services See details
Home Health Services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HealthSpring TotalCare Plus (HMO D-SNP) plan with no copay and no coinsurance, although some services are covered but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance for days 1 through 100, though prior authorization is required. This benefit allows for admission without a prior three-day inpatient hospital stay, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered under the HealthSpring TotalCare Plus (HMO D-SNP) plan, which offers over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $165 every three months for OTC items, and meal benefits are provided for qualifying chronic or medical conditions.
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