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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 2026 to people living in Washington DC. 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 $21.00. 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 $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 Plus (PPO) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay for one-month, two-month, or three-month supplies when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, with a $4 copay for a one-month supply at preferred locations and no copay for a three-month supply through preferred mail order. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply across all pharmacy and mail-order options. For higher-tier medications, you will pay a coinsurance percentage instead of a copay, which includes 50% coinsurance for Tier 4 non-preferred drugs and 25% coinsurance for a one-month supply of Tier 5 specialty drugs. Utilizing preferred pharmacies and preferred mail-order services under this plan is the most effective way to minimize your out-of-pocket prescription expenses.
Additional Benefits
The HealthSpring True Choice Plus (PPO) plan offers robust medical coverage with no copay or coinsurance for primary care doctor visits and home health services. Specialist visits, outpatient procedures, and emergency room care are covered with predictable, flat copayments and no coinsurance. For inpatient hospital stays, members pay a daily copayment for the first six days, followed by no copay for additional Medicare-covered days. Supplemental benefits include preventive and comprehensive dental care with no copay up to an $850 annual maximum, as well as routine vision exams and a $100 eyewear allowance. Routine hearing exams and hearing aids are also covered with set copayments and no coinsurance, while durable medical equipment and dialysis services require a 20% coinsurance. This plan provides clear cost transparency by utilizing fixed copays for the majority of healthcare services.
Inpatient Hospital See details
HealthSpring True Choice Plus (PPO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $225 for days 1 through 6 of acute stays and $230 for days 1 through 6 of psychiatric stays, followed by no copay for days 7 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by HealthSpring True Choice Plus (PPO) with no coinsurance, featuring a $0 to $375 copay for outpatient hospital services and a $375 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay or coinsurance, while outpatient substance abuse sessions carry a $45 copay and no coinsurance.
Partial Hospitalization See details
HealthSpring True Choice Plus (PPO) covers partial hospitalization services with a $140.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring True Choice Plus (PPO) covers ground ambulance services with a $265 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HealthSpring True Choice Plus (PPO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum limit with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring True Choice Plus (PPO) offers primary care physician services with no copay and no coinsurance, while specialist, mental health, psychiatric, and opioid treatment services require a $45 copay and no coinsurance. Physical and occupational therapy cost a $35 copay with no coinsurance, telehealth ranges from a $0 to $45 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by HealthSpring True Choice Plus (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and glaucoma screenings. While some additional preventive services are covered, sub-services such as fitness benefits, health education, and weight management programs are not covered.
Hearing Services See details
HealthSpring True Choice Plus (PPO) covers hearing services, including routine hearing exams for a $25 copay and no coinsurance, and OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $399 to $1800 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring True Choice Plus (PPO) partially covers vision services with no deductibles, offering one routine eye exam per year with a $0 to $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear, including lenses, frames, and contacts, is covered with no copay and no coinsurance up to a $100 annual maximum.
Dental Services See details
HealthSpring True Choice Plus (PPO) covers Medicare-covered dental services with a $45 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. These dental benefits, which include exams, cleanings, and restorative services, are subject to a combined in-network and out-of-network annual maximum coverage limit of $850.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring True Choice Plus (PPO) with no copay, though prior authorization is required and step therapy may apply. Associated Medicare Part B chemotherapy, radiation, and insulin drugs carry a coinsurance ranging from no coinsurance up to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring True Choice Plus (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HealthSpring True Choice Plus (PPO) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. This benefit is partially covered because diabetic supplies are not covered under the plan, and prior authorization is required for covered equipment.
Diagnostic and Radiological Services See details
HealthSpring True Choice Plus (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, while diagnostic tests range from no copay up to $50, outpatient X-rays require a $35 copay, and therapeutic radiology has a minimum copay of $85.
Home Health Services See details
Home health services are covered under the HealthSpring True Choice Plus (PPO) plan 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 Plus (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation (with a $50 copay), pulmonary rehabilitation (with a $35 copay), and supervised exercise therapy for symptomatic peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) services are covered by HealthSpring True Choice Plus (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100 per admission. Prior authorization is required and a prior three-day inpatient hospital stay is not necessary, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring True Choice Plus (PPO) partially covers other services, offering a meal benefit for chronic illnesses or qualifying medical conditions with no copay and no coinsurance. However, acupuncture and over-the-counter (OTC) items are not covered under this plan.
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