A non-government entity
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 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 (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 $3200.00 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:
Sign up for HealthSpring TotalCare (HMO D-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HealthSpring TotalCare (HMO D-SNP) plan features an annual prescription drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay when using preferred pharmacies or preferred mail order, while standard options charge a $19 copay for a one-month supply. Tier 2 generic drugs carry a $20 copay for a one-month supply, but you can receive a three-month supply for no copay when using preferred mail order. Higher-tier medications require coinsurance instead of flat copayments. Tier 3 preferred brand drugs require a 23% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance at all pharmacy types. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply under both preferred and standard pharmacy options.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers comprehensive coverage with many essential medical services requiring no copay and no coinsurance, including primary care, home health, and preventive care. For hospital stays, members pay a $175 daily copay for days one through five and no copay for subsequent days, while emergency room visits carry a $135 copay that is waived upon admission. Specialist visits, physical therapy, and diagnostic services generally feature no copay with coinsurance ranging up to 20%. Supplemental benefits are also highly accessible, featuring routine dental and vision services with no copay and up to 20% coinsurance, plus a $300 annual allowance for eyewear. Members can also access over-the-counter items with no copay up to a limit of $100 every three months. Additionally, skilled nursing facility stays require no copay for the first 20 days, and hearing aid coverage is available with copays starting at $399 and no coinsurance.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $175 copay per day for days 1 through 5 and no copay for days 6 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient hospital services with no coinsurance and a copay ranging from no copay to $175, while ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance. Outpatient substance abuse services are also covered with no copay but carry a 20% coinsurance for individual and group sessions.
Partial Hospitalization See details
HealthSpring TotalCare (HMO D-SNP) covers partial hospitalization services with a $100 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services under HealthSpring TotalCare (HMO D-SNP) cover ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $135 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services are covered with no copay or coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $135 copay per service and no coinsurance, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and telehealth require no copay and up to 20% coinsurance. Podiatry is not covered, and although chiropractic, psychiatric, and mental health specialty services are technically covered, routine chiropractic care as well as individual and group sessions are not covered.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered; physical and memory fitness programs are included, but sub-services such as health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing Services covered by HealthSpring TotalCare (HMO D-SNP) include annual routine hearing exams with no copay and 20% coinsurance, plus fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800, though inner ear, outer ear, and over-the-ear models are not covered. Up to two OTC hearing aids per year are also covered with a $399 copay and no coinsurance.
Vision Services See details
Vision services are covered by HealthSpring TotalCare (HMO D-SNP), featuring one routine eye exam per year with no copay and 0% to 20% coinsurance, though other eye exam services are not covered. Covered eyewear, including contact lenses and one pair of eyeglasses per year, has no copay or coinsurance up to a $300 annual maximum benefit.
Dental Services See details
Dental services are covered by HealthSpring TotalCare (HMO D-SNP), with Medicare-covered dental services requiring no copay and a 20% coinsurance. Other preventive and comprehensive dental services, including exams, cleanings, and implants, are covered with no copay and no coinsurance up to a maximum plan benefit of $1,450 per year.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, insulin, and other drugs under this benefit require no coinsurance to 20% coinsurance, with insulin drugs also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered under this plan, offering coverage for therapeutic shoes and inserts with no copay and a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring TotalCare (HMO D-SNP), with prior authorization and referrals required. Lab services and diagnostic radiological services feature no copay and no coinsurance, while diagnostic procedures and tests require a copay with no coinsurance. Therapeutic radiological services and outpatient X-rays have no copay but require a 20% coinsurance.
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 offered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, requiring both a referral and prior authorization. While some services are covered, specific programs including 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, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) provides partial coverage for Other Services, offering meal benefits and over-the-counter (OTC) items with no copay and no coinsurance. Covered OTC items are limited to $100 every three months, while acupuncture and other additional services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved