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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 North Carolina. 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 $820.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $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 combined Maximum Out-Of-Pocket cost of $10100.00 (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 $10100.00 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 plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic prescriptions are also highly affordable, starting with a $5 copay for a one-month supply at preferred locations. For Tier 3 preferred brand drugs, the plan charges a flat $47 copay for a one-month supply across all pharmacy and mail order options. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance. These tier-based copays and coinsurance rates help you easily estimate your out-of-pocket prescription costs with this plan.
Additional Benefits
The HealthSpring True Choice (PPO) plan offers affordable access to everyday healthcare with no copay and no coinsurance for primary care visits, preventive care, and home health services. Routine dental care is also fully covered with no copay up to a $900 annual limit, while routine vision exams feature low copays and an eyewear allowance. For specialist visits, urgent care, and emergency services, members can expect predictable flat copays with no coinsurance. When intensive medical care is required, inpatient hospital stays and skilled nursing facility care are structured around set daily copays rather than coinsurance. Conversely, services like dialysis, durable medical equipment, and certain Part B drugs require a 20% coinsurance with no copay. This plan is designed to keep routine wellness affordable while outlining clear cost-sharing expectations for major medical events.
Inpatient Hospital See details
HealthSpring True Choice (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $315 daily copay for days 1 through 5 of acute stays and a $595 daily copay for days 1 through 3 of psychiatric stays, with no copays for the remaining days of a stay. Hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring True Choice (PPO) covers outpatient services with no coinsurance, featuring a copay ranging from $0 to $315 for outpatient hospital services and a $315 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $50 copay per session and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the HealthSpring True Choice (PPO) plan with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring True Choice (PPO), offering ground ambulance services for a $270.00 copay with no coinsurance and air ambulance services for a 20% coinsurance with no copay. Prior authorization is required for all ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
HealthSpring True Choice (PPO) covers emergency services 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 $50 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 require a $50 copay and no coinsurance. Therapy and mental health services carry a $45 copay with no coinsurance, but podiatry is not covered, and for chiropractic care, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
HealthSpring True Choice (PPO) covers preventive services, including annual physical exams, kidney disease education, and a fitness benefit, with no copay and no coinsurance. However, additional preventive services are only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home/bathroom safety modifications, and counseling services are not covered.
Hearing Services See details
Hearing services are partially covered by HealthSpring True Choice (PPO), offering annual routine exams and fitting evaluations for a $30 copay and no coinsurance. Up to two OTC or prescription hearing aids are covered annually with no coinsurance and copays ranging from $399 to $1,800, although inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
HealthSpring True Choice (PPO) vision services are partially covered, offering one routine eye exam per year with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a combined maximum benefit of $200 per year for contact lenses, eyeglasses, and upgrades.
Dental Services See details
Dental Services are covered by HealthSpring True Choice (PPO) with no copay and no coinsurance for preventive and comprehensive care, up to a combined in- and out-of-network annual maximum of $900. Medicare-covered dental services are also available for a $50 copay and no coinsurance, though prior authorization is required.
Home Infusion bundled Services See details
HealthSpring True Choice (PPO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the HealthSpring True Choice (PPO) plan with no copay and a 20% coinsurance, subject to prior authorization.
Medical Equipment See details
HealthSpring True Choice (PPO) partially covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. Under this plan, durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring True Choice (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays have no copay, while diagnostic procedures and tests range from a $0 to $95 copay, diagnostic radiological services start with no copay, and therapeutic radiological services have a minimum copay of $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
HealthSpring True Choice (PPO) offers cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. While some services are covered, specific programs such as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring True Choice (PPO) with no coinsurance, requiring a daily copay of $10 for days 1 to 20, $218 for days 21 to 60, and no copay for days 61 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HealthSpring True Choice (PPO), which features a limited-duration meal benefit with no copay and no coinsurance for qualifying chronic or medical conditions. Acupuncture, over-the-counter (OTC) items, and other additional services are not covered under this plan.
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