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HealthSpring True Choice (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring True Choice (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring True Choice (PPO) in 2026, please refer to our full plan details page.
HealthSpring True Choice (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Southern Illinois. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that HealthSpring True Choice (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthSpring True Choice (PPO).
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 True Choice (PPO), 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 has a $750.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $200.00 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 combined Maximum Out-Of-Pocket cost of $6050.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $6050.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 True Choice (PPO) Medicare prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, starting at a $4 copay for a one-month supply at preferred locations and dropping to no copay for a three-month supply through preferred mail order. For Tier 3 preferred brand drugs, you will pay a flat $47 copay for a one-month supply regardless of whether you use a standard or preferred pharmacy. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring True Choice (PPO) plan offers comprehensive medical coverage with predictable costs, including no copay and no coinsurance for primary care doctor visits and covered preventive services. Specialist visits, urgent care, and emergency services require straightforward copays, ranging from $40 to $130 with no coinsurance. For hospital stays, members pay daily copays for the first six days of inpatient care and no copay for subsequent days, while outpatient hospital services feature copays up to $295. This plan also includes key supplemental benefits like dental care and eyewear with no copay up to specified annual limits, alongside routine hearing exams for a $20 copay. While home health and cardiac rehabilitation services are covered with no copay, diagnostic services, medical equipment, and dialysis require either set copays or a 20% coinsurance. Additionally, covered Part B drugs and insulin are subject to coinsurance up to 20% or capped copays.
Inpatient Hospital See details
HealthSpring True Choice (PPO) covers inpatient hospital services with no coinsurance, requiring a $250 daily copay for days 1 to 6 of acute care and a $300 daily copay for days 1 to 6 of psychiatric care, with no copay for days 7 and beyond. While acute care includes unlimited additional days, psychiatric care is limited to 90 days, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring True Choice (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a $0 to $295 copay, observation services require a $295 copay per stay, and outpatient substance abuse sessions have a $40 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring True Choice (PPO) with an $85 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring True Choice (PPO) partially covers ambulance and transportation services, though transportation to plan-approved or health-related locations is not covered. Ground ambulance services require a $230 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for both.
Emergency Services See details
Emergency services are covered under the HealthSpring True Choice (PPO) plan with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $45 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring True Choice (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits, therapy services, and opioid treatment require a $40 copay and no coinsurance. Telehealth and other health professional services range from no copay to a $40 copay with no coinsurance, though chiropractic and podiatry services are not covered, and mental health and psychiatric benefits exclude individual and group sessions.
Preventive Services See details
HealthSpring True Choice (PPO) offers partially covered preventive services with no copay and no coinsurance, which include annual physical exams, kidney disease education, and fitness benefits. However, multiple sub-services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
HealthSpring True Choice (PPO) partially covers hearing services, offering routine hearing exams for a $20 copay and no coinsurance, and OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $399 to $1,800 and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring True Choice (PPO), offering routine eye exams with a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $150 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
HealthSpring True Choice (PPO) covers dental services, offering Medicare-covered dental care with a $40 copay and no coinsurance. Preventive and comprehensive dental services are covered with no copay and no coinsurance up to a combined in-network and out-of-network maximum benefit of $800 per year.
Home Infusion bundled Services See details
HealthSpring True Choice (PPO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring True Choice (PPO) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
HealthSpring True Choice (PPO) offers medical equipment coverage with no copays and a 20% coinsurance, subject to prior authorization. This benefit is partially covered, as durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring True Choice (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Lab services and diagnostic radiological services have no copay, while outpatient x-rays have a $10 copay, diagnostic procedures range from a $0 to $50 copay, and therapeutic radiological services require a copay starting at $85.
Home Health Services See details
HealthSpring True Choice (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the HealthSpring True Choice (PPO) plan with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring True Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100 per stay. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
HealthSpring True Choice (PPO) partially covers other services, providing over-the-counter (OTC) items up to $15 every three months and home meal benefits with no copay and no coinsurance. Acupuncture is not covered under this plan.
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