HealthSpring TotalCare (HMO D-SNP)
Available to residents of Paulding County, GA for 2026. Contract H0439, plan 002, segment 0.
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- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
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Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $3.40 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $3.40? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $6,750.00? |
| Drug deductible | $615.00Tier 1 exempt |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO D-SNP? |
| Special needs plan | Dual-eligible SNP |
| Contract / plan | H0439-002-0 |
| Offered by | Cigna HealthCare |
| Parent organization | Health Care Service Corporation |
| Formulary drugs | 3,659 |
| Formulary exception tier | 4? |
| Pharmacy search | www.cigna.com/medicare |
| Member services | (855)265-6004TTY 711 |
CMS star ratings
- Overall
- 3.5 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 3.5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H0439 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $0 copay(authorization required) |
| Other health care professional | $0 copay(authorization required) |
| Additional telehealth services | $0 copay(authorization required) |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | 0%–20% coinsurance(authorization required) |
| Lab services | $0–$50 copay(authorization required) |
| Diagnostic radiology (e.g. MRI, CT) | 0%–20% coinsurance(authorization required) |
| Therapeutic radiology | 20% coinsurance(authorization required) |
| Outpatient x-rays | 0%–20% coinsurance(authorization required) |
| Emergency and urgent care | |
| Emergency room | $130 copay |
| Urgent care | $50 copay |
| Worldwide emergency coverage | $130 copay · $50,000 plan limit |
| Worldwide urgent care | $130 copay · $50,000 plan limit |
| Worldwide emergency transportation | $130 copay |
| Hospital care | |
| Inpatient hospital stay | $1,775 per stay(authorization required) |
| Outpatient hospital services | 0%–20% coinsurance(authorization required) |
| Outpatient observation | 20% coinsurance(authorization required) |
| Ambulatory surgical center | 0%–20% coinsurance(authorization required) |
| Outpatient blood services | $0 copay |
| Skilled nursing and home health | |
| Skilled nursing facility | $10 per day for days 1–20; $218 per day for days 21–100(authorization required) |
| Home health care | $0 copay(authorization required) |
| Kidney dialysis | 20% coinsurance(authorization required) |
| Rehabilitation | |
| Occupational therapy | $0 copay(authorization required) |
| Physical therapy and speech-language therapy | $0 copay(authorization required) |
| Cardiac rehabilitation | $0 copay(authorization required) |
| Pulmonary rehabilitation | $0 copay(authorization required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $1,850 per stay(authorization required) |
| Outpatient mental health, individual session | $0 copay(authorization required) |
| Outpatient mental health, group session | $0 copay(authorization required) |
| Psychiatrist, individual session | $0 copay(authorization required) |
| Psychiatrist, group session | $0 copay(authorization required) |
| Partial hospitalization | $140 copay(authorization required) |
| Intensive outpatient program | $140 copay(authorization required) |
| Outpatient substance use, individual session | $0 copay(authorization required) |
| Outpatient substance use, group session | $0 copay(authorization required) |
| Opioid treatment program | $0 copay(authorization required) |
| Ambulance and transportation | |
| Ground ambulance | $275 copay(authorization required) |
| Air ambulance | 20% coinsurance(authorization required) |
| Transportation to plan-approved locations | $0 copay(authorization required, limits apply) |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $0 copay(authorization required) |
| Routine chiropractic care | Not covered |
| Acupuncture | Not covered |
| Foot exams and treatment (Medicare-covered) | $0 copay |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $0 copay(authorization required) |
| Preventive dental plan limit | $2,650 plan limit every year |
| Oral exams | $0 copay |
| Cleanings | $0 copay |
| Fluoride treatment | $0 copay |
| Dental x-rays | $0 copay |
| Other diagnostic dental services | $0 copay |
| Other preventive dental services | $0 copay |
| Restorative services (fillings, crowns) | $0 copay |
| Endodontics (root canals) | $0 copay |
| Periodontics (gum disease) | $0 copay |
| Dentures and other removable prosthodontics | $0 copay |
| Maxillofacial prosthetics | $0 copay |
| Implants | $0 copay |
| Bridges and other fixed prosthodontics | $0 copay |
| Oral and maxillofacial surgery | $0 copay |
| Orthodontics | $0 copay |
| Adjunctive general services | $0 copay |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay |
| Routine eye exam | $0 copay(limits apply) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(limits apply) |
| Eyewear plan limit | $300 plan limit every year |
| Contact lenses | $0 copay(limits apply) |
| Eyeglasses (frames and lenses) | $0 copay(limits apply) |
| Eyeglass lenses | $0 copay(limits apply) |
| Eyeglass frames | $0 copay(limits apply) |
| Eyewear upgrades | $0 copay(limits apply) |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay |
| Routine hearing exam | $0 copay(limits apply) |
| Hearing aid fitting and evaluation | $0 copay(limits apply) |
| Hearing aids (all types) | $399–$1,800 copay(limits apply) |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Chemotherapy and radiation drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other Part B drugs | 0%–20% coinsurance(authorization required, step therapy may apply) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $200 allowance every three months |
| Meals after a hospital stay or for a chronic condition | $0 copay |
| Fitness benefit | $0 copay |
| Health education | Not covered |
| Nutritional / dietary benefit | Not covered |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | Not covered |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | $0 copay |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $20.00 |
| Tier 3 | 24% |
| Tier 4 | 25% |
| Tier 5 | 25% |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial deductible phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $19.00 | $0.00 | $0.00 | $57.00 | $0.00 |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $19.00 | $0.00 | $0.00 | $57.00 | $0.00 |
| Tier 2: Generic | $20.00 | $20.00 | $20.00 | $60.00 | $60.00 | $0.00 |
| Tier 3: Preferred Brand | 24% | 24% | 24% | 24% | 24% | 24% |
| Tier 4: Non-Preferred Drug | 25% | 25% | 25% | 25% | 25% | 25% |
| Tier 5: Specialty Tier | 25% | 25% | 25% | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 47 other GA counties
- Banks
- Barrow
- Bartow
- Bryan
- Butts
- Carroll
- Chatham
- Chattooga
- Cherokee
- Clarke
- Clayton
- Cobb
- Coweta
- Dawson
- DeKalb
- Douglas
- Effingham
- Fayette
- Floyd
- Forsyth
- Franklin
- Fulton
- Gordon
- Greene
- Gwinnett
- Habersham
- Hall
- Haralson
- Harris
- Heard
- Henry
- Jackson
- Lumpkin
- Madison
- Morgan
- Muscogee
- Newton
- Oconee
- Oglethorpe
- Pickens
- Polk
- Rockdale
- Spalding
- Stephens
- Troup
- Walton
- White
Benefits in plain text
HealthSpring TotalCare (HMO D-SNP) (H0439-002-0) is a 2026 HMO D-SNP Medicare Advantage plan offered by Cigna HealthCare, available to residents of Paulding County, GA.
The monthly premium is $3.40 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $6,750.00.
The drug deductible is $615.00. Tier 1 exempt.
It is a special needs plan (Dual-eligible SNP).
The plan's formulary lists 3,659 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $20.00; tier 3: 24%; tier 4: 25%; tier 5: 25%.
CMS gives the plan's contract (H0439) an overall rating of 3.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.