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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 Daytona/Jacksonville. 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 drug deductible of $615. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs carry a $20 copay for a one-month supply, but you pay no copay for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs require a 23% coinsurance across all pharmacy and mail order options. Tier 4 non-preferred drugs have a 24% coinsurance at preferred pharmacies and mail order, which increases to 25% coinsurance at standard locations. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply at both standard and preferred pharmacies.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) offers robust coverage with no copay and no coinsurance for most core medical services, including inpatient hospital stays, primary care, and specialist visits. Beneficiaries also enjoy no copay or coinsurance for preventive care, emergency services, dialysis, and skilled nursing facility stays for up to 100 days. This comprehensive plan minimizes out-of-pocket costs for essential healthcare, making it an attractive option for those seeking predictable expenses. In addition to medical care, the plan provides valuable supplemental benefits, including a $2,500 annual dental allowance and $325 yearly for eyewear with no copay or coinsurance. While routine hearing exams have no copay, prescription hearing aids require a copay between $399 and $1,800. Members also benefit from a $125 quarterly allowance for over-the-counter items with no copay, though certain services like air ambulance and select Part B drugs require up to a 20 percent coinsurance.
Inpatient Hospital See details
Inpatient hospital and psychiatric services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. The benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. While some outpatient substance abuse services are covered, individual and group sessions are not covered.
Partial Hospitalization See details
HealthSpring TotalCare Plus (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring TotalCare Plus (HMO D-SNP) offers partially covered ambulance and transportation services, featuring unlimited one-way trips to plan-approved locations with no copay or coinsurance. Air ambulance services are covered with a 20% coinsurance and no copay, but ground ambulance services and transportation to any health-related location are 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, up to a maximum plan benefit limit of $50,000.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) covers primary care, specialist visits, physical therapy, telehealth, and opioid treatment with no copay and no coinsurance. Podiatry is not covered, and while some services are covered for chiropractic, mental health, and psychiatric care, routine or other chiropractic services and individual or group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, featuring a fitness benefit but excluding sub-services such as health education, in-home safety assessments, and nutritional therapy.
Hearing Services See details
Hearing services are covered by HealthSpring TotalCare Plus (HMO D-SNP), offering no copay and no coinsurance for annual routine hearing exams and fittings. Prescription hearing aids are partially covered with a copay ranging from $399 to $1,800 and no coinsurance (inner ear, outer ear, and over the ear types are not covered), while up to two OTC hearing aids are covered annually with a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay, coinsurance, or deductible, though other eye exam services are not covered. The plan covers one routine eye exam per year and provides up to $325 annually for eyewear, including contact lenses, frames, lenses, and upgrades with no copays or coinsurance.
Dental Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers comprehensive dental services with no copay and no coinsurance, up to a maximum annual benefit of $2,500. This coverage includes preventive care, exams, cleanings, restorative services, and implants, though Medicare-covered dental services require prior authorization.
Home Infusion bundled Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers home infusion bundled services with no copay, requiring prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers dialysis services with no copay and no coinsurance. Prior authorization and a referral are required to access this covered benefit.
Medical Equipment See details
Medical Equipment is covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance, including Durable Medical Equipment which requires prior authorization. For prosthetics and diabetic equipment, some services are covered but prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP) with no coinsurance, though referrals and prior authorization are required. While lab services are covered with no copay, diagnostic procedures, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers cardiac rehabilitation services with no copay and no coinsurance, though prior authorization and referrals are required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance for days 1 through 100 per stay, though prior authorization is required. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, but it does allow admission without a prior three-day inpatient hospital stay.
Other Services See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers Other Services, offering meal benefits and over-the-counter items with a maximum $125 quarterly allowance at no copay and no coinsurance. Acupuncture, highly integrated services, and other additional services are not covered under this plan.
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* 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.
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