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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 Southeast Florida. 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 $3500.00 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) prescription drug plan has an annual drug deductible of $615. You can save on Tier 1 preferred generic drugs with no copay when using preferred pharmacies or preferred mail order, compared to a $19 monthly copay at standard pharmacies. Tier 2 generic drugs generally carry a $20 monthly copay, though you can receive a three-month supply with no copay through preferred mail order. For higher-tier medications, Tier 3 preferred brand drugs require a 23% coinsurance across all standard and preferred pharmacy options. Tier 4 non-preferred drugs and Tier 5 specialty drugs both require 25% coinsurance for your prescription fills. Choosing preferred network pharmacies and mail-order services helps maximize your benefits and lower out-of-pocket expenses under this plan.
Additional Benefits
The HealthSpring TotalCare (HMO D-SNP) plan offers coverage with no copays or coinsurance for many essential healthcare services. Members pay no copay for primary care, specialist visits, preventive care, home health care, and outpatient hospital services. Additionally, the plan includes valuable supplemental benefits with no copays, such as routine dental care up to $2,500 annually, routine hearing and vision exams, and up to 50 routine one-way transportation trips per year. For other medical needs, inpatient hospital stays require a copay of $650 for acute care or $500 for psychiatric care, while dialysis and certain Part B drugs require a 20% coinsurance. Emergency room visits feature a $150 copay, which is waived if you are admitted within 24 hours. The plan also supports daily wellness by offering a $155 quarterly over-the-counter drug allowance and home meal benefits for qualifying conditions.
Inpatient Hospital See details
HealthSpring TotalCare (HMO D-SNP) covers inpatient hospital services, with a $650 copay per stay for acute care and a $500 copay per stay for psychiatric care, both featuring no coinsurance. This coverage is partial, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. For outpatient substance abuse services, some services are covered, but individual and group sessions are not covered.
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 for these covered benefits.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HealthSpring TotalCare (HMO D-SNP), with prior authorization required for covered services. Air ambulance services are covered with a 20% coinsurance and no copay, but ground ambulance services are not covered. Routine transportation is covered with no copay and no coinsurance for up to 50 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under HealthSpring TotalCare (HMO D-SNP) are covered with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay or coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare (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 chiropractic care, individual and group mental health sessions, and individual and group psychiatric sessions are not covered.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) provides partially covered preventive services with no copay and no coinsurance for covered care such as annual physical exams, fitness benefits, and kidney disease education. However, several additional services are not covered under this benefit, including health education, in-home safety assessments, personal emergency response systems, and nutritional or dietary benefits.
Hearing Services See details
HealthSpring TotalCare (HMO D-SNP) covers annual routine hearing exams and fitting evaluations with no copay, no coinsurance, and no deductible. Prescription and OTC hearing aids are covered for up to two devices per year with no coinsurance and copays ranging from $399 to $1,800, though inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring TotalCare (HMO D-SNP) with no copay, no coinsurance, and no deductible, as other eye exam services are not covered. Covered benefits include one routine eye exam per year and up to $350 annually for eyewear, which covers contact lenses, frames, lenses, and upgrades.
Dental Services See details
HealthSpring TotalCare (HMO D-SNP) offers comprehensive and preventive dental services with no copay and no coinsurance, up to a maximum yearly benefit of $2,500. Covered services include exams, cleanings, x-rays, implants, and orthodontics, with prior authorization required for Medicare-covered dental services.
Home Infusion bundled Services See details
HealthSpring TotalCare (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance up to 20% coinsurance, while covered Part B insulin has a $35 copay and no coinsurance up to 20% coinsurance.
Dialysis Services See details
HealthSpring TotalCare (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) covers durable medical equipment with no copay and no coinsurance, subject to prior authorization. While some non-Medicare prosthetic, medical supply, and diabetic equipment services are covered with no copay and no coinsurance, prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
HealthSpring TotalCare (HMO D-SNP) offers partial coverage for diagnostic and radiological services, featuring covered lab services with no copay and no coinsurance, and therapeutic radiological services with a 20% coinsurance and no copay. Diagnostic procedures, diagnostic radiological services, and outpatient X-ray services are not covered, and prior authorization and referrals are required for all covered services.
Home Health Services See details
Home Health Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring TotalCare (HMO D-SNP) plan, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance for days 1 through 100, although prior authorization is required. This benefit is partially covered as additional days beyond the Medicare-covered limit are not covered, and a prior three-day inpatient hospital stay is not required for admission.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) provides partially covered other services with no copay and no coinsurance, which include a $155 quarterly over-the-counter (OTC) drug allowance and home meal benefits, though acupuncture is not covered. The meal benefit is available for members with chronic or qualifying medical conditions, and the OTC benefit covers essential items including nicotine replacement therapy and naloxone.
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