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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 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 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 $0.00. 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 $5000.00 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 features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members enjoy no copay when using a preferred pharmacy or preferred mail order service. Standard pharmacies and standard mail order services require a copay starting at $5 for Tier 1 and $13 for Tier 2. For higher-tier medications, costs transition to a coinsurance model across all pharmacy and mail order channels. Tier 3 preferred brands require a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 25% coinsurance. These percentages apply regardless of whether you choose preferred or standard services.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers robust medical coverage with no copays and no coinsurance for many essential services, including inpatient hospital stays, primary care, and outpatient services. Members also enjoy no copays or coinsurance for skilled nursing facility stays up to 100 days, home health care, dialysis, and durable medical equipment. Standard emergency services and unlimited transportation to plan-approved health locations are also covered with no copays or coinsurance. Ancillary benefits include comprehensive dental coverage up to a $3,000 yearly maximum and a $350 annual eyewear allowance, both with no copays or coinsurance. Routine hearing exams have no copay, while prescription and over-the-counter hearing aids require copays ranging from $399 to $1,800. Additionally, members receive a $120 over-the-counter allowance every three months and a chronic-illness meal benefit with no copays or coinsurance.
Inpatient Hospital See details
HealthSpring TotalCare Plus (HMO D-SNP) covers inpatient hospital services, including acute and psychiatric stays, with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered as additional days, upgrades, 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 blood services with no copay and no coinsurance. While some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions for outpatient substance abuse are not covered.
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
HealthSpring TotalCare Plus (HMO D-SNP) offers partially covered ambulance and transportation services, both requiring prior authorization. Air ambulance services are covered with a 20% coinsurance and no copay, while ground ambulance services and transportation to non-approved locations are not covered; however, unlimited transportation to plan-approved health locations is available with no copay and no coinsurance.
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 care, and emergency transportation are also covered with no coinsurance and a $130 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 visits, telehealth, and occupational and physical therapies with no copay and no coinsurance, though prior authorization is required. Podiatry is not covered, and chiropractic, mental health, and psychiatric services are only partially covered, excluding routine chiropractic care and individual or group therapy sessions.
Preventive Services See details
Preventive services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance for annual physicals, kidney education, and fitness benefits. However, additional preventive services are only partially covered, 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/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services covered by HealthSpring TotalCare Plus (HMO D-SNP) include annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $399 to $1,800 for up to two aids per year, excluding inner ear, outer ear, and over the ear types. OTC hearing aids are also covered with a $399 copay and no coinsurance for up to two devices annually.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) offers partially covered vision services with no copay and no coinsurance, though other eye exam services are not covered. Covered benefits include one routine eye exam per year and up to $350 annually for eyewear, including contacts, frames, lenses, and upgrades, all with no copay or coinsurance.
Dental Services See details
Dental services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and no coinsurance for preventive, comprehensive, and orthodontic treatments, up to a $3,000 yearly maximum. Medicare-covered dental services also feature no copay and no coinsurance, but require prior authorization.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Dialysis Services with no copay and no coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring TotalCare Plus (HMO D-SNP) covers durable medical equipment with no copay and no coinsurance, though prior authorization is required. While some prosthetic and diabetic equipment services are covered under the plan, 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 under HealthSpring TotalCare Plus (HMO D-SNP) are partially covered, offering lab services with no copay and no coinsurance, subject to prior authorization. However, diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient x-rays are not covered under this benefit.
Home Health Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization. However, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Skilled Nursing Facility (SNF) services for days 1 through 100 with no copay and no coinsurance, though prior authorization is required. A prior three-day inpatient hospital stay is not required for admission, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers other services, providing over-the-counter (OTC) items up to $120 every three months and a chronic-illness meal benefit with no copay and no coinsurance. Acupuncture, highly integrated dual-eligible SNP services, and other additional services are not covered.
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