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HealthSpring TotalCare Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring TotalCare Plus (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 Plus (HMO D-SNP) in 2026, please refer to our full plan details page.
HealthSpring TotalCare Plus (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 Plus (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 Plus (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 Plus (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 Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.20. 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 $8200.00 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 Plus (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. For Tier 1 preferred generics, members pay no copay when using preferred pharmacies or preferred mail order, while standard options require a $19 copay for a one-month supply. Tier 2 generic drugs generally require a $20 copay for a one-month supply, but you can secure a three-month supply with no copay through preferred mail order. Higher-tier medications on this plan are subject to coinsurance instead of flat copays. Tier 3 preferred brands require a 23% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require 25% coinsurance. These coinsurance percentages remain the same whether you use preferred or standard pharmacies and mail-order services.
Additional Benefits
The HealthSpring TotalCare Plus (HMO D-SNP) plan offers robust healthcare coverage with no copays for many essential medical services. Primary care visits, specialist consultations, and diagnostic labs require no copayments, though a 20% coinsurance generally applies to these services. For emergency needs, members pay a $115 copay for emergency room visits and a $40 copay for urgent care, with no coinsurance required. Supplemental benefits provide additional value, highlighted by comprehensive dental services covered up to a $4,000 annual limit with no copay or coinsurance. Members also receive a $350 yearly allowance for eyewear and $205 every three months for over-the-counter items, both with no copays or coinsurance. Routine vision and hearing exams are also accessible with no copayments, though some coinsurance or specific copays may apply for hearing aids.
Inpatient Hospital See details
HealthSpring TotalCare Plus (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance and Medicare-defined copays, subject to prior authorization. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers outpatient services with no copayments, though coinsurance ranges from 0% to 20% depending on the service. Outpatient hospital and ambulatory surgical center services require a 0% to 20% coinsurance, outpatient substance abuse services carry a 20% coinsurance, and outpatient blood services have no copay or coinsurance.
Partial Hospitalization See details
HealthSpring TotalCare Plus (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers ground and air ambulance services with a 20% coinsurance and no copay, subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 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 with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring TotalCare Plus (HMO D-SNP) covers primary care, specialist visits, physical therapy, occupational therapy, and telehealth services with no copay and a 20% coinsurance (0% to 20% for telehealth), though prior authorization is generally required. Podiatry is not covered, and while chiropractic, mental health specialty, and psychiatric services are technically covered, their primary sub-services—including routine chiropractic care and individual or group therapy sessions—are not covered.
Preventive Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Medicare-covered preventive services, kidney disease education, and routine screenings with no copay and no coinsurance, though an annual physical exam requires a 20% coinsurance and no copay. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness and caregiver support, but services such as health education, in-home safety assessments, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring TotalCare Plus (HMO D-SNP), including one annual routine exam with no copay and 20% coinsurance, and one fitting evaluation with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay of $399 to $1,800 and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. Additionally, up to two OTC hearing aids are covered annually with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring TotalCare Plus (HMO D-SNP) offers partially covered vision services, including one annual routine eye exam with no copay and a 0% to 20% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $350 combined annual maximum for contact lenses, upgrades, and one pair of eyeglasses per year.
Dental Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers comprehensive dental services with no copay and no coinsurance up to a $4,000 annual maximum, including preventive, restorative, and orthodontic care. Medicare-covered dental services are also available with no copay and a 20% coinsurance, subject to prior authorization.
Home Infusion bundled Services See details
Home infusion bundled services are covered under HealthSpring TotalCare Plus (HMO D-SNP) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered, as diabetic therapeutic shoes and inserts are included, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring TotalCare Plus (HMO D-SNP) covers diagnostic and radiological services with prior authorization and no copays. Patients pay no coinsurance for diagnostic tests, lab services, and diagnostic radiological services, but a 20% coinsurance applies to therapeutic radiological and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered under the HealthSpring TotalCare Plus (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring TotalCare Plus (HMO D-SNP) with no copay, though prior authorization is required. While some services are covered, specific sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
HealthSpring TotalCare Plus (HMO D-SNP) partially covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required. While a prior three-day inpatient hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HealthSpring TotalCare Plus (HMO D-SNP), which provides over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Acupuncture and dual-eligible highly integrated services are not covered, but eligible members receive up to $205 every three months for OTC items.
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