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HealthSpring Preferred (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Preferred (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Preferred (HMO) in 2026, please refer to our full plan details page.
HealthSpring Preferred (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Central Arizona. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HealthSpring Preferred (HMO) 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 Preferred (HMO).
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 Preferred (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $200.00 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 $2750.00 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
HealthSpring Preferred (HMO) features an Enhanced Alternative drug benefit with a $200 yearly prescription drug deductible. During the initial coverage phase, you will pay a $4 copay for Tier 1 preferred generic drugs at preferred pharmacies and mail-order, or a $20 copay at standard locations. Tier 2 standard generics require a $47 copay, while Tier 3 preferred brands have a 50% coinsurance and Tier 4 non-preferred drugs have a 30% coinsurance. If you qualify for the low-income subsidy, you will have no cost for your Part D premium. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
HealthSpring Preferred (HMO) provides comprehensive health coverage with no copays for preventive services and annual physical exams. Inpatient hospital stays require a $180 daily copay for the first seven days, while emergency room visits carry a $150 copay that is waived if you are admitted. Outpatient care and specialist visits are highly affordable, with copays ranging from no copay up to $30 and no coinsurance. This plan also includes essential extra benefits like routine dental and hearing care, which feature predictable copays and no coinsurance. Vision care is covered with a $200 annual eyewear allowance and routine exams that have no copay or a low copay. Additionally, members can access up to 24 one-way transportation trips per year with no copay, while durable medical equipment and dialysis services generally require a 20% coinsurance with no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient hospital services with a $180 copay for days 1 through 7 and no copay or coinsurance for days 8 through 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center services with no copay. Other covered options require copays, ranging from $0 to $190 for outpatient hospital services, $150 per stay for observation services, and $30 per session for outpatient substance abuse services.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization benefits with a $175.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HealthSpring Preferred (HMO), as transportation to any health-related location is not covered. Ground ambulance services require a $250 copay and no coinsurance, air ambulance services require a 20% coinsurance and no copay, and approved transportation is limited to 24 one-way trips per year with no copay or coinsurance.
Emergency Services See details
Emergency services are covered by HealthSpring Preferred (HMO) with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to $50,000 with a $150 copay and no coinsurance.
Primary Care See details
Primary Care is partially covered under HealthSpring Preferred (HMO), as psychiatric services and mental health specialty services are not covered. Covered options like specialist visits, physical therapy, and telehealth require copays ranging from no copay to $30, with no coinsurance.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copays or coinsurance. Additional preventive benefits are only partially covered, as services such as health education, weight management, alternative therapies, therapeutic massage, and adult day health services are not covered.
Hearing Services See details
Hearing services are partially covered by HealthSpring Preferred (HMO), with prescription hearing aids for the inner ear, outer ear, and over the ear excluded from coverage. Routine hearing exams and fitting evaluations require a $20 copay with no coinsurance, while covered prescription hearing aids (all types) and OTC hearing aids have copays ranging from $399 to $1,800 and no coinsurance.
Vision Services See details
HealthSpring Preferred (HMO) covers one routine eye exam per year with a copay ranging from no copay to $20 and no coinsurance. Eyewear, including contacts and eyeglasses, is also covered up to a $200 annual maximum with no deductible, no copay, and no coinsurance.
Dental Services See details
Dental services are partially covered by HealthSpring Preferred (HMO), with maxillofacial prosthetics and orthodontics being excluded from coverage. Medicare-covered dental services require a $20 copay and no coinsurance, while other covered services feature no coinsurance and copays ranging from no copay up to $950, up to a $20,000 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered under HealthSpring Preferred (HMO) with prior authorization, featuring a coinsurance ranging from no coinsurance to 20% and no copay for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred (HMO) with a 20% coinsurance and no copay. Prior authorization is required to receive this benefit.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment, offering durable medical equipment, prosthetic devices, and medical supplies with no copay and a 20% coinsurance. Diabetic supplies and diabetic therapeutic shoes or inserts are not covered, and prior authorization is required for covered equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring Preferred (HMO) and require prior authorization, with diagnostic procedures and tests being not covered. Covered benefits include lab services with no copay and no coinsurance, outpatient X-rays for a $10 copay and no coinsurance, diagnostic radiological services with a $0 to $150 copay and no coinsurance, and therapeutic radiological services with a 20% coinsurance and a copay.
Home Health Services See details
Home health services are covered under the HealthSpring Preferred (HMO) plan, though prior authorization is required and specific copay or coinsurance information is not provided.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring Preferred (HMO) plan. In practice, none of the associated sub-services are covered, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100, with no coinsurance. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by HealthSpring Preferred (HMO), offering a $45 quarterly over-the-counter item allowance and a limited meal benefit for chronic conditions with no copay or coinsurance. Acupuncture and dual-eligible SNP services are not covered under this benefit.
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