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HealthSpring TotalCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring TotalCare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring TotalCare (HMO D-SNP) in 2026, please refer to our full plan details page.
HealthSpring TotalCare (HMO D-SNP) is a HMO D-SNP 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 4 out of 5 stars in 2026.
It's important to know that HealthSpring TotalCare (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HealthSpring TotalCare (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthSpring TotalCare (HMO D-SNP).
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 TotalCare (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.70. 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 Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 TotalCare (HMO D-SNP) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when utilizing a preferred pharmacy or preferred mail order service. Tier 2 generic drugs generally cost a $20 copay for a one-month supply, though you can receive a three-month supply with no copay through preferred mail order. Brand-name and higher-tier medications are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. Specialty tier medications are restricted to a one-month supply across all standard and preferred pharmacy channels.
Additional Benefits
HealthSpring TotalCare (HMO D-SNP) offers robust coverage with no copay or coinsurance for primary care visits, specialist consultations, routine preventive care, and home health services. However, acute inpatient hospital stays require a $1,545 copay per admission, and outpatient services may carry up to a 20% coinsurance with no copay. Emergency room visits are covered with a $115 copay, which is waived if you are admitted within 24 hours. This plan also includes valuable supplemental benefits, such as comprehensive dental services with no copay up to a $2,000 annual maximum. Vision and hearing routine exams are covered with no copay, though prescription hearing aids require copays ranging from $399 to $1,800. Members also benefit from a $55 quarterly over-the-counter allowance and up to 24 free one-way transportation trips per year.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HealthSpring TotalCare (HMO D-SNP), excluding upgrades, non-Medicare-covered stays, and additional psychiatric days. Acute inpatient stays require a $1,545 copay per admission with no coinsurance, while psychiatric stays require a $1,700 copay per admission with no coinsurance, both requiring prior authorization.
Outpatient Services See details
HealthSpring TotalCare (HMO D-SNP) covers outpatient services with no copay, though coinsurance ranges from no coinsurance up to 20% depending on the service. Outpatient hospital, ambulatory surgical center, and substance abuse services require prior authorization and carry up to 20% coinsurance, while outpatient blood services have no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring TotalCare (HMO D-SNP) with a $105.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring TotalCare (HMO D-SNP), with ground ambulance requiring a $240 copay and air ambulance services requiring a 20% coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by HealthSpring TotalCare (HMO D-SNP) with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services carry a $40 copay and no coinsurance, while worldwide emergency care, urgent care, and transportation are covered up to a $50,000 maximum limit with a $115 copay and no coinsurance.
Primary Care See details
Primary care benefits under HealthSpring TotalCare (HMO D-SNP) are covered with no copay and no coinsurance for primary care, specialist, telehealth, and therapy services, though prior authorization is required. Podiatry is not covered, opioid treatment requires no copay and a 20% coinsurance, and only some services are covered for chiropractic, mental health, and psychiatric benefits, which exclude routine chiropractic care and individual or group therapy sessions.
Preventive Services See details
HealthSpring TotalCare (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance for covered services like annual physicals, caregiver support, and fitness benefits. However, sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for chemotherapy-related hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring TotalCare (HMO D-SNP), offering annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800—excluding inner ear, outer ear, and over the ear models—while OTC hearing aids are covered with a $399 copay and no coinsurance for up to two devices per year.
Vision Services See details
Vision Services are partially covered by HealthSpring TotalCare (HMO D-SNP), offering routine eye exams and eyewear with no copay and no coinsurance. The plan covers one routine eye exam per year and provides a $250 annual maximum for contacts, frames, and lenses, but other eye exam services are not covered.
Dental Services See details
Dental services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay and no coinsurance, up to a maximum annual plan benefit of $2,000. This comprehensive coverage includes preventive, diagnostic, restorative, and orthodontic services, though prior authorization is required for Medicare-covered dental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HealthSpring TotalCare (HMO D-SNP) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs are covered with no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HealthSpring TotalCare (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required before receiving these services.
Medical Equipment See details
HealthSpring TotalCare (HMO D-SNP) partially covers medical equipment, as diabetic supplies are not covered. Covered items, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, require prior authorization and feature no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring TotalCare (HMO D-SNP) with prior authorization, offering diagnostic radiology and X-rays with no copays or coinsurance. Diagnostic tests require a copay with no coinsurance, while lab services and therapeutic radiology require coinsurance (including a 20% coinsurance for therapeutic services) and no copays.
Home Health Services See details
Home Health Services are covered under the HealthSpring TotalCare (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring TotalCare (HMO D-SNP) technically covers some cardiac rehabilitation services with no copay and no coinsurance, subject to prior authorization, but in practice, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring TotalCare (HMO D-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 to 20 and days 61 to 100, though a $218 daily copay applies for days 21 to 60, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring TotalCare (HMO D-SNP) partially covers other services, providing over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $55 every three months for OTC items, and a limited-duration meal benefit is available for those with chronic illnesses or medical conditions requiring them to remain at home.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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