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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 Orlando/Tampa. 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 $2950.00 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) plan has an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay when using preferred pharmacies or preferred mail order, whereas standard pharmacies and standard mail order require a $19 copay for a one-month supply. Tier 2 generic drugs carry a $20 copay for a one-month supply, but you pay no copay for a three-month supply ordered through preferred mail order. Tier 3 preferred brand drugs require a 23% coinsurance across all pharmacy and mail-order options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance for a one-month supply. These percentage-based costs apply equally whether you choose preferred or standard network pharmacies.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays and no coinsurance for primary care visits, preventive services, and routine home health care. For inpatient hospital stays, members pay a $175 daily copay for the first five days and no copay for days six through 90, while emergency room visits carry a $135 copay that is waived upon admission. Specialized outpatient care, diagnostic services, and medical equipment generally require no copay but may involve up to a 20% coinsurance. Additional benefits include dental and vision care, featuring no copays and no coinsurance for routine dental up to a $2,100 annual limit and eyewear up to a $200 yearly limit. Members also benefit from unlimited free transportation to approved health locations and a $70 quarterly allowance for over-the-counter health items. Hearing aids are partially covered with copays ranging from $399 to $1,800, while routine hearing exams require no copay and a 20% coinsurance.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) provides partially covered inpatient hospital services with no coinsurance, featuring a $175 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. While unlimited additional acute care days are covered, upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services with no copay and no coinsurance for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $175 with no coinsurance, while outpatient observation services carry a $175 copay per stay. Outpatient substance abuse services have no copay but require a 20% coinsurance for individual and group sessions.
Partial Hospitalization See details
HealthSpring TotalCare (HMO D-SNP) covers partial hospitalization services with a $100.00 copay and no coinsurance. Prior authorization is required before receiving this care.
Ambulance and Transportation Services See details
HealthSpring TotalCare (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered, offering unlimited rides to plan-approved health-related locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare (HMO D-SNP) covers emergency services with a $135 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $135 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare (HMO D-SNP) offers primary care physician services with no copay and no coinsurance. Covered specialist, physical, occupational, speech therapy, telehealth, and opioid treatment services require no copay and up to 20% coinsurance, while chiropractic, podiatry, mental health, and psychiatric services are not covered.
Preventive Services See details
Preventive services are partially covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and fitness benefits. However, numerous supplemental services, including health education, in-home safety assessments, and medical nutrition therapy, are not covered.
Hearing Services See details
Hearing services covered by HealthSpring TotalCare (HMO D-SNP) include one annual routine exam with no copay and 20% coinsurance, and one annual fitting evaluation with no copay. Prescription hearing aids are partially covered with no coinsurance and a $399 to $1,800 copay for up to two devices yearly, though inner ear, outer ear, and over-the-ear types are not covered. Up to two OTC hearing aids are also covered annually with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare (HMO D-SNP) provides partially covered vision services with no deductibles, though other eye exam services are not covered. Routine eye exams are covered once annually with no copay and a 0% to 20% coinsurance, while eyewear is covered with no copay or coinsurance up to a $200 yearly limit.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) covers Medicare-covered dental services with no copay and 20% coinsurance, subject to prior authorization. Other preventive and comprehensive dental services, including cleanings, x-rays, implants, and orthodontics, are covered with no copay and no coinsurance up to a $2,100 annual maximum.
Home Infusion bundled Services See details
HealthSpring TotalCare (HMO D-SNP) covers home infusion bundled services with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%. Covered Medicare Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
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 services.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) medical equipment benefits are partially covered with no copay and a 20% coinsurance, with prior authorization required. While durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
HealthSpring TotalCare (HMO D-SNP) covers diagnostic and radiological services with prior authorization and referral requirements. Under this plan, diagnostic tests require a copay with no coinsurance, lab services have no copay, and while diagnostic radiological services have no copay or coinsurance, therapeutic radiological and X-ray services require a 20% minimum coinsurance with no copay.
Home Health Services See details
Home Health Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services, are not covered under the HealthSpring TotalCare (HMO D-SNP) plan.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing for admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though 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 over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. Members receive a $70 OTC allowance every three months for health-related items, alongside home-delivered meals for qualifying chronic or medical conditions.
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