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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 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 (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 $350.00 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, compared to a $10 copay for a one-month supply at standard pharmacies. Tier 2 generic medications cost a $4 copay for a one-month supply at preferred pharmacies and preferred mail order, while standard options charge a $20 copay. For Tier 3 preferred brand drugs, there is a flat $47 copay for a one-month supply regardless of whether you use a preferred or standard pharmacy. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs at a 50% coinsurance and Tier 5 specialty drugs at a 25% coinsurance for a one-month supply. Utilizing preferred network pharmacies and mail-order services provides the lowest out-of-pocket costs for generic medications under this plan.
Additional Benefits
The HealthSpring True Choice (PPO) plan offers comprehensive medical coverage featuring no copays for primary care visits, preventive services, home health, and lab tests. Specialist visits, urgent care, and emergency services require predictable copays, such as $40 for specialists and $130 for emergency care, with no coinsurance. For hospital stays, members pay daily copays for the first few days of inpatient care and skilled nursing facility stays, while outpatient services carry copays ranging from no copay up to $285. Supplemental benefits include dental care with no copay for non-Medicare services up to a $1,400 annual limit, and vision coverage featuring routine exams and a $250 eyewear allowance with no copay or deductible. Hearing exams and hearing aids are covered with copays and no coinsurance, while durable medical equipment, Part B drugs, and dialysis services require up to a 20% coinsurance. This PPO plan minimizes member out-of-pocket costs by utilizing flat copayments instead of coinsurance for the vast majority of medical and diagnostic services.
Inpatient Hospital See details
HealthSpring True Choice (PPO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $350 for days 1 to 6 of acute stays and $595 for days 1 to 3 of psychiatric stays, with no copay for subsequent days. 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, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services carry a copay of $0 to $285, observation services require a $285 copay per stay, and outpatient substance abuse sessions have a $40 copay, with prior authorization required for most services.
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 these services.
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, both of which require prior authorization. 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 urgently needed services with a $50 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. 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
HealthSpring True Choice (PPO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, mental health, psychiatric, and opioid treatment services require a $40 copay and no coinsurance. Telehealth and other healthcare professional services range from a $0 to $40 copay with no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring True Choice (PPO) with no copay and no coinsurance, including annual physicals, kidney disease education, and fitness benefits. However, these additional services are only partially covered, as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
HealthSpring True Choice (PPO) covers annual routine hearing exams and fittings for a $30 copay and no coinsurance. OTC hearing aids are covered for a $399 copay with no coinsurance, while prescription hearing aids are partially covered with a copay between $399 and $1,800 and no coinsurance, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring True Choice (PPO), featuring one routine eye exam per year with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear options including contacts, frames, lenses, and upgrades have no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $250 per year.
Dental Services See details
HealthSpring True Choice (PPO) covers Medicare dental services with a $40 copay and no coinsurance, and other dental services with no copay and no coinsurance. Other preventive and comprehensive dental services are subject to a combined in-network and out-of-network maximum annual benefit of $1,400.
Home Infusion bundled Services See details
Home infusion bundled services are covered under HealthSpring True Choice (PPO) with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and insulin, have coinsurance ranging from no coinsurance 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, although prior authorization is required.
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, subject to prior authorization. Diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the HealthSpring True Choice (PPO) with no coinsurance, although prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests require a copay of $0 to $95, and therapeutic radiological services have a minimum copay of $85.
Home Health Services See details
Home health services are covered under the HealthSpring True Choice (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring True Choice (PPO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation 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
Other Services are partially covered under the HealthSpring True Choice (PPO) plan, which features a meal benefit with no copay and no coinsurance for eligible chronic illnesses or home-confining medical conditions. Acupuncture and over-the-counter (OTC) items are not covered under this benefit.
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