Plan year 2027 · Medicare AdvantageCMS files of Sept. 22 and Oct. 1, 2026
HealthSpring TotalCare, 2027
H4513Contract027Plan
HMO D-SNP · special needs plan, dual-eligible · 6 counties in Texas
Run by HealthSpring Life & Health Insurance Company, Inc. (contract H4513), sold as HealthSpring, owned by Health Care Service Corporation
HealthSpring TotalCare (H4513-027) costs $0.90 a month in 2027, up $0.90 from 2026, with an in-network out-of-pocket limit of $9,850 ($3,400 in 2026). Some of its 2026 members move to H4513-105 instead (CMS crosswalk).
What changes from 2026 to 2027?
| What you pay or get | 2026 | 2027 | Change |
|---|---|---|---|
| Monthly premium | $0 | $0.90 | ▲up $0.90 |
| In-network out-of-pocket limit | $3,400 | $9,850 | ▲up $6,450 |
| Drug deductible | $615 | $700 | ▲up $85 |
| Emergency room | $150 copay | $115 copay | ▼down $35 |
| Hospital stay, in network | $0 a stay | $200 a day for days 1–5, then $0 a day for days 6–90 | ▲up $1,000for a 5-day stay |
| Skilled nursing facility, in network | $20 a day for days 1–20, then $218 a day for days 21–100 | $0 a day for days 1–20, then $221 a day for days 21–100 | ▼down $370for a 30-day stay |
| Ground ambulance, in network | $75 copay | 20% of the cost | changed |
| Eyewear, yearly limit | $300 a year | $200 a year | ▼down $100 |
| Over-the-counter items, yearly | $800 a year | $180 a year | ▼down $620 |
| Counties served | 7 | 6 | ▼down 1 |
| Drug tier 3, preferred brand | 24% of the cost | 20% of the cost | ▼down 4 points |
| 10 lines do not change | |||
| Part B premium reduction, monthly | none | none | no change |
| Primary care visit | $0 copay | $0 copay | no change |
| Specialist visit | $0 copay | $0 copay | no change |
| Medical deductible, in network | none | none | no change |
| Comprehensive dental, yearly limit | not offered | not offered | no change |
| Hearing aids, yearly limit for both ears | not offered | not offered | no change |
| Drug tier 1, preferred generic | $5 | $5 | no change |
| Drug tier 2, generic | $10 | $10 | no change |
| Drug tier 4, non-preferred drug | 25% of the cost | 25% of the cost | no change |
| Drug tier 5, specialty tier | 25% of the cost | 25% of the cost | no change |
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS plan benefit package files, 2027 and 2026; CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026). Plan details can change during the year; confirm on Medicare Plan Finder.
What will prescriptions cost?
| Tier | What the tier holds | 2026, standard pharmacy | 2027, standard pharmacy | 2027, preferred pharmacy |
|---|---|---|---|---|
| Tier 1 | Preferred Generic | $5 | $5 | $0 |
| Tier 2 | Generic | $10 | $10 | $5 |
| Tier 3 | Preferred Brand | 24% of the cost | 20% of the cost | 20% of the cost |
| Tier 4 | Non-Preferred Drug | 25% of the cost | 25% of the cost | 25% of the cost |
| Tier 5 | Specialty Tier | 25% of the cost | 25% of the cost | 25% of the cost |
Source: CMS plan benefit package files, 2027 and 2026. Insulin is capped at $35 a month by law. A drug's tier is set by the plan's formulary.
How does it compare with plans sold where it is?
In the counties it serves, 22 dual-eligible special needs plans are sold for 2027, this one included. Against the others, 1 plan has a lower out-of-pocket limit, 20 the same. On the premium, 21 plans have a lower premium.
Out-of-pocket limits of the 22 dual-eligible special needs plans
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where is it sold, and what does it cost there?
It stops serving 1 county it served in 2026 (listed in the next section).
The premium and the out-of-pocket limit are the same in all 6 counties: $0.90 a month and $9,850.
Texas
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision).
Where do its 2026 members go?
The CMS crosswalk moves the members of the 2026 plan into 2 plans for 2027. It names the plans but not which member goes to which; the counties show where each 2027 plan is sold, and the plan's Annual Notice of Change says which one is yours.
| 2027 plan | Sold in | Members in those counties, Sept. 2026 | Premium 2027 | Limit 2027 |
|---|---|---|---|---|
| Stays in this plan | 6 of its 7 2026 counties, in Texas | 565 | $0.90 | $9,850 |
| HealthSpring TotalCare PlusH4513-105 | 6 of its 7 2026 counties, in Texas | 565 | $0 | $9,850 |
In 1 county it served in 2026 (Henderson, TX) none of these plans is sold; members there choose a new plan by December 31 to have no gap (they can still join until the end of February 2027, with coverage from the first of the next month).
Source: CMS plan crosswalk from 2026 to 2027 (Oct. 1, 2026); CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11).
Who runs this plan?
- Plan ID
- H4513-027
- Legal name of the contract
- HealthSpring Life & Health Insurance Company, Inc.
- Sold as
- HealthSpring
- Parent company
- Health Care Service Corporation
- Plan type
- HMO D-SNP
- 2026 star rating of the contract
- 4.5 of 5 overall; health plan 4.5 of 5, drug plan 3.5 of 5
- Members, September 2026
- 704
- Plan website, as filed with CMS
- HealthSpringMedicare.com
Source: CMS Medicare Advantage and Part D landscape files for 2027 (Sept. 22, 2026, revised Sept. 30) and 2026 (Sept. 2, 2026 revision); CMS 2026 Star Ratings (October 2025); CMS monthly enrollment by plan and by county, September 2026 (CMS hides counts under 11). CMS publishes the 2027 Star Ratings in October 2026.
What else should you check?
- Other 2027 plans in Smith, TXWhere most of its members live; premiums and limits side by side
- Every HealthSpring plan for 2027Its contracts, counties and plans that end
- The other 49 plans of contract H4513Same company, same contract
- Is your prescription covered?Coverage share and tier for 2,259 drugs
Data, not advice. These are the plan's filed amounts, not a quote for you; confirm on Medicare Plan Finder or call the plan before you enroll.