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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 $675.00 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 prescription drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or preferred mail order services. Tier 2 generic drugs start at a low $5 copay for a one-month supply at preferred locations, compared to a $20 copay at standard pharmacies. Tier 3 preferred brand drugs carry a consistent $47 copay for a one-month supply across both standard and preferred pharmacies. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 25% coinsurance for a one-month supply. This plan offers clear cost-saving opportunities when choosing preferred network pharmacies for your prescription needs.
Additional Benefits
HealthSpring True Choice (PPO) offers comprehensive medical coverage featuring no copay for primary care doctor visits, annual physical exams, and preventive services. For hospital care, members pay a $290 copay per day for the first six days of inpatient stays, while outpatient hospital services range from no copay to a $315 copay. Emergency room visits require a $130 copay, which is waived if you are admitted to the hospital within 24 hours. The plan also features valuable everyday care benefits, including preventive and comprehensive dental care with no copay up to a $600 annual limit, and a $200 yearly allowance for eyewear with no copay. Routine hearing exams are available for a $25 copay, alongside coverage for up to two hearing aids per year. Additionally, home health services require no copay, while durable medical equipment and dialysis services are covered with a 20% coinsurance.
Inpatient Hospital See details
HealthSpring True Choice (PPO) covers inpatient hospital services with no coinsurance, requiring a $290 copay for days 1 to 6 of acute stays and a $595 copay for days 1 to 3 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered, as hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring True Choice (PPO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $315, alongside ambulatory surgical center and blood services offered with no copay and no coinsurance. Outpatient substance abuse services require a $45 copay with no coinsurance, and observation services have a $315 copay per stay.
Partial Hospitalization See details
HealthSpring True Choice (PPO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HealthSpring True Choice (PPO) covers ground ambulance services with a $270 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to plan-approved or other 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 have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 limit 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, alongside telehealth services ranging from a $0 to $45 copay with no coinsurance. Specialist visits, physical therapy, occupational therapy, and mental health services require a $45 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HealthSpring True Choice (PPO) preventive services are covered with no copay and no coinsurance, including annual physical exams, kidney education, and diabetes self-management training. This benefit is partially covered, offering a fitness benefit but excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing Services are partially covered by HealthSpring True Choice (PPO), offering annual routine hearing exams and fitting evaluations for a $25 copay and no coinsurance. Up to two prescription or OTC hearing aids are covered yearly with no coinsurance and copays ranging from $399 to $1,800, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring True Choice (PPO) partially covers vision services, offering routine eye exams with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $200 combined annual maximum allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
HealthSpring True Choice (PPO) covers Medicare-covered dental services with a $45 copay and no coinsurance, while preventive and comprehensive dental services are covered with no copay and no coinsurance. Non-Medicare dental services, such as cleanings, x-rays, and restorative care, are subject to a combined in-network and out-of-network maximum benefit of $600 per year.
Home Infusion bundled Services See details
HealthSpring True Choice (PPO) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Medicare Part B drugs associated with these services, including chemotherapy and insulin, have a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring True Choice (PPO) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
HealthSpring True Choice (PPO) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts. This benefit is partially covered because diabetic supplies are not covered, and prior authorization is required for all covered equipment.
Diagnostic and Radiological Services See details
HealthSpring True Choice (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Members will pay no copay for lab services and outpatient X-rays, a copay of $0 to $75 for diagnostic procedures and tests, and a minimum copay of $85 for therapeutic radiological services.
Home Health Services See details
Home health services are covered by HealthSpring True Choice (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring True Choice (PPO) with no coinsurance and prior authorization required, though only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require copays ranging from $25 to $50.
Skilled Nursing Facility (SNF) See details
HealthSpring True Choice (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20, a $218 daily copay 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
HealthSpring True Choice (PPO) partially covers other services, offering a limited-duration meal benefit for chronic illnesses or home recovery with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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