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HealthSpring True Choice Plus (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring True Choice Plus (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 Plus (PPO) in 2026, please refer to our full plan details page.
HealthSpring True Choice Plus (PPO) is a PPO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that HealthSpring True Choice Plus (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 Plus (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 Plus (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 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 combined Maximum Out-Of-Pocket cost of $6200.00 (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 $6200.00 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 Plus (PPO) prescription drug plan features an annual drug deductible of $615. Tier 1 preferred generic drugs have no copay when filled at a preferred pharmacy or through preferred mail order, while standard pharmacies charge a $10 copay for a one-month supply. For Tier 2 generic medications, you will pay a $4 copay for a one-month supply at preferred pharmacies, and there is no copay for a three-month supply filled via preferred mail order. Tier 3 preferred brand drugs carry a consistent $47 copay for a one-month supply regardless of whether you use preferred, standard, or mail-order pharmacies. For higher-tier prescriptions, the plan utilizes coinsurance rather than flat copays, charging 50% coinsurance for Tier 4 non-preferred drugs and 25% coinsurance for Tier 5 specialty drugs.
Additional Benefits
HealthSpring True Choice Plus (PPO) offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. For specialist visits and Medicare-covered dental services, members pay a low $25 copay and no coinsurance, while emergency room visits carry a $150 copay. Inpatient hospital stays require daily copays ranging from $290 to $595 for the first few days before transitioning to no copay, with no coinsurance applied. Diagnostic lab services, outpatient x-rays, and home infusions are available with no copay, whereas durable medical equipment and dialysis services require a 20% coinsurance with no copay. Routine hearing exams carry a $25 copay, and vision exams range from no copay to $10, though routine dental care and eyewear are not covered under this plan. Skilled nursing facility stays are also covered with daily copays for the first 60 days and no copay thereafter.
Inpatient Hospital See details
Inpatient hospital services are covered by HealthSpring True Choice Plus (PPO) with no coinsurance, requiring prior authorization and daily copays of $290 for days 1 through 6 of acute care and $595 for days 1 through 3 of psychiatric care, followed by no copay for remaining stay days. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient Services covered by HealthSpring True Choice Plus (PPO) feature no coinsurance across all services, with no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $275, observation services have a $275 copay per stay, and outpatient substance abuse sessions carry a $25 copay, with prior authorization required for most of these benefits.
Partial Hospitalization See details
HealthSpring True Choice Plus (PPO) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
HealthSpring True Choice Plus (PPO) partially covers ambulance and transportation services, requiring prior authorization for ambulance services which carry a $270 copay (no coinsurance) for ground transport and a 20% coinsurance (no copay) for air transport. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
HealthSpring True Choice Plus (PPO) covers emergency services with a $150 copay and urgently needed services with a $60 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance, up to a maximum benefit of $50,000.
Primary Care See details
HealthSpring True Choice Plus (PPO) features primary care physician services with no copay and no coinsurance, while specialist visits, physical and occupational therapies, and mental health services require a $25 copay and no coinsurance. Podiatry services are not covered, and chiropractic services are technically covered but its routine and other sub-services are not.
Preventive Services See details
HealthSpring True Choice Plus (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits, such as fitness programs, health education, and personal emergency response systems, are not covered.
Hearing Services See details
HealthSpring True Choice Plus (PPO) partially covers hearing services, including annual routine exams and fittings for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $399 to $1,800 and no coinsurance, excluding inner ear, outer ear, and over the ear types. OTC hearing aids are covered with a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring True Choice Plus (PPO), which offers one routine eye exam per year with no coinsurance and a copay ranging from no copay to $10. Other eye exams and all eyewear, including contact lenses and eyeglasses, are not covered.
Dental Services See details
HealthSpring True Choice Plus (PPO) partially covers dental services, offering coverage only for Medicare-covered dental services with a $25 copay, no coinsurance, and prior authorization requirements. Routine and comprehensive dental services, including oral exams, cleanings, x-rays, fluoride, restorative services, and orthodontics, are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring True Choice Plus (PPO) with no copay, though prior authorization and step therapy are required. Covered Medicare Part B drugs, including chemotherapy and other infusion drugs, require no coinsurance to 20% coinsurance, while insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring True Choice Plus (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HealthSpring True Choice Plus (PPO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is partially covered under this plan with no copay and a 20% coinsurance for therapeutic shoes and inserts, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring True Choice Plus (PPO) with no coinsurance, though prior authorization is required. Members pay no copay for lab services and outpatient x-rays, while diagnostic procedures and tests have a copay of $0 to $95 and therapeutic radiological services require a minimum copay of $85.
Home Health Services See details
HealthSpring True Choice Plus (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 Plus (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring True Choice Plus (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $20 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 100-day Medicare limit are not covered.
Other Services See details
Other services are covered by HealthSpring True Choice Plus (PPO), but only some services are covered as acupuncture, over-the-counter (OTC) items, and meal benefits are not covered.
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