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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 $570.00 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) plan features an annual prescription 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 drugs cost as low as a $5 copay for a one-month supply at preferred locations, with no copay required for a three-month supply filled via preferred mail order. For Tier 3 preferred brand drugs, you will pay a consistent $47 copay for a one-month supply at both preferred and standard pharmacies. Higher-tier medications transition to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance across all pharmacy options. Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The HealthSpring True Choice (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialized care, members pay a predictable $30 copay for specialist visits, while emergency room services require a $130 copay. Inpatient hospital stays feature daily copays for the first few days and no copay for longer stays, all with no coinsurance required. Ancillary benefits include preventive and comprehensive dental care with no copay up to a $1,600 annual limit, alongside routine vision exams and a $250 annual allowance for eyewear. Routine hearing exams carry a $25 copay, with hearing aid coverage available at varying copays and no coinsurance. Diagnostic labs and outpatient X-rays are available with no copay, while medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
HealthSpring True Choice (PPO) offers partially covered inpatient hospital services with no coinsurance and required prior authorization. Under this plan, acute stays require a $325 copay per day for days 1 to 6 and no copay for days 7 to 90, while psychiatric stays require a $595 copay per day for days 1 to 3 and no copay for days 4 to 90. Specific sub-services including non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HealthSpring True Choice (PPO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $315, observation services require a $315 copay per stay, and outpatient substance abuse sessions require a $30 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization benefits are covered under the HealthSpring True Choice (PPO) plan with a $140.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HealthSpring True Choice (PPO) covers ambulance services with prior authorization required, charging a $270 copay and no coinsurance for ground services, and a 20% coinsurance with no copay for air services. Routine 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, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a maximum plan benefit of $50,000.
Primary Care See details
Primary care benefits under the HealthSpring True Choice (PPO) feature no copay and no coinsurance for primary care provider visits, while specialists, therapies, psychiatric care, and opioid treatment require a $30 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine and other chiropractic care are not covered, and podiatry services are not covered.
Preventive Services See details
HealthSpring True Choice (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered, offering a physical and memory fitness benefit but excluding services such as health education, medical nutrition therapy, and in-home safety assessments.
Hearing Services See details
HealthSpring True Choice (PPO) covers routine hearing exams and fitting evaluations for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800 for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered with a $399 copay and no coinsurance for up to two devices per year.
Vision Services See details
HealthSpring True Choice (PPO) offers partially covered vision services, which exclude other eye exam services but cover one routine eye exam per year with a $0 to $30 copay and no coinsurance. Eyewear is also covered with no copay, no coinsurance, and a $250 annual combined maximum limit for contacts, lenses, frames, and upgrades.
Dental Services See details
HealthSpring True Choice (PPO) covers Medicare-approved dental services with a $30 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. These dental benefits are subject to a combined annual in-network and out-of-network maximum coverage limit of $1,600.
Home Infusion bundled Services See details
HealthSpring True Choice (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin drugs have a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
HealthSpring True Choice (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HealthSpring True Choice (PPO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though prior authorization is required. Diabetic supplies are not covered under this plan, and diabetic shoes and inserts are limited to specified manufacturers.
Diagnostic and Radiological Services See details
HealthSpring True Choice (PPO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. There is no copay for lab services and outpatient x-rays, while diagnostic tests range from no copay to $75, diagnostic radiology starts at no copay, and therapeutic radiology requires 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
Cardiac Rehabilitation Services are covered by HealthSpring True Choice (PPO) with no coinsurance, though prior authorization is required. While some services are covered, the plan does not cover cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($35 copay), and SET for PAD services ($25 copay) in practice.
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 21, $20 for days 22 through 60, and no copay for days 61 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring True Choice (PPO) partially covers other services, which includes a limited-duration meal benefit for chronic or qualifying medical conditions with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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