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HealthSpring Achieve (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Achieve (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Achieve (HMO C-SNP) in 2026, please refer to our full plan details page.
HealthSpring Achieve (HMO C-SNP) is a HMO C-SNP 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 Achieve (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HealthSpring Achieve (HMO C-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 Achieve (HMO C-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 Achieve (HMO C-SNP), 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. Additionally, this plan comes with a Part B Premium reduction of $7.00. You must continue to pay paying your reduced 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 $2500.00 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 Achieve (HMO C-SNP) plan offers an Enhanced Alternative drug benefit with a $200 annual prescription drug deductible. If you qualify for the low-income subsidy (LIS), you will have no copay for your Part D premium. During the initial coverage phase, Tier 1 preferred generics cost as low as a $4 copay at preferred pharmacies, while standard generic drugs carry a $47 copay. For other tiers, you will pay a 50% coinsurance for Tier 3 preferred brands and a 30% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase. In this final phase, you pay nothing and have no copay for Medicare Part D covered drugs.
Additional Benefits
The HealthSpring Achieve (HMO C-SNP) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for preventive services and primary care visits ranging from no copay to 20 dollars. Inpatient hospital stays require a 165 dollar daily copay for the first six days, followed by no copay for days seven through 90. Outpatient surgical services and laboratory tests are also covered with no copay, while emergency room visits carry a 150 dollar copay that is waived if you are admitted. For extra wellness needs, members receive a 350 dollar annual eyewear allowance with no copay, a 20,000 dollar annual limit on dental care with no coinsurance, and routine hearing exams for a 10 dollar copay. The plan also includes an 80 dollar quarterly allowance for over-the-counter items and up to 40 one-way transportation trips per year to plan-approved locations. While durable medical equipment and dialysis require a 20 percent coinsurance, there are no deductibles for eyewear or outpatient blood services.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by HealthSpring Achieve (HMO C-SNP) with no coinsurance, requiring a $165 daily copay for days 1 through 6 and no copay for days 7 through 90 for acute and psychiatric stays. Prior authorization is required, and non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by HealthSpring Achieve (HMO C-SNP) with no coinsurance, featuring no copay for ambulatory surgical center services and a $0 to $175 copay for outpatient hospital services. Patients will pay a $175 copay per stay for observation services, a $20 copay per session for outpatient substance abuse services, and no deductible for outpatient blood services.
Partial Hospitalization See details
HealthSpring Achieve (HMO C-SNP) covers partial hospitalization benefits with a copay of $175.00 and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring Achieve (HMO C-SNP), featuring a $200 copay and coinsurance for ground ambulance, and a 20% coinsurance and copay for air ambulance. Transportation benefits are partially covered, offering up to 40 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Achieve (HMO C-SNP) covers emergency services 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 $20 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
HealthSpring Achieve (HMO C-SNP) covers primary care benefits with copays ranging from no copay up to $20 and no coinsurance for services such as chiropractic, physical therapy, and specialist visits. This benefit is partially covered, as psychiatric services and mental health specialty services are not covered under the plan.
Preventive Services See details
HealthSpring Achieve (HMO C-SNP) covers Medicare-covered zero-dollar preventive services, annual physicals, and kidney education with no copay or coinsurance. Additional preventive services are partially covered, excluding health education, personal emergency response systems, weight management, alternative therapies, and home safety devices. Other services like glaucoma screenings and diabetes self-management training are fully covered with no referral required.
Hearing Services See details
HealthSpring Achieve (HMO C-SNP) covers annual routine hearing exams and fittings for a $10 copay and no coinsurance, as well as OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by HealthSpring Achieve (HMO C-SNP), including one routine eye exam per year with a copay ranging from no copay to $10 and no coinsurance. Members also receive a $350 annual allowance for eyewear, including contacts, lenses, frames, and upgrades, with no copay, no coinsurance, and no deductible.
Dental Services See details
Dental services are partially covered by HealthSpring Achieve (HMO C-SNP) up to a $20,000 annual limit, though orthodontics and maxillofacial prosthetics are not covered. Covered benefits require no coinsurance, with copays ranging from no copay up to $950 depending on the service, and a $10 copay for Medicare-covered dental care.
Home Infusion bundled Services See details
HealthSpring Achieve (HMO C-SNP) partially covers Home Infusion bundled Services, which require prior authorization and exclude Part D home infusion drugs. Covered Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%, while other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Achieve (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HealthSpring Achieve (HMO C-SNP) provides partial coverage for medical equipment, with covered items like durable medical equipment, prosthetics, and medical supplies requiring no copay and a 20% coinsurance. Diabetic supplies and diabetic therapeutic shoes or inserts are not covered under this plan.
Diagnostic and Radiological Services See details
HealthSpring Achieve (HMO C-SNP) partially covers diagnostic and radiological services, as diagnostic procedures and tests are not covered. Covered lab services require no copay or coinsurance, outpatient X-rays require a $10 copay and coinsurance, diagnostic radiology has a copay of up to $150 and no coinsurance, and therapeutic radiology requires a 20% coinsurance and no copay.
Home Health Services See details
Home Health Services are covered under the HealthSpring Achieve (HMO C-SNP) plan, though prior authorization is required before services can be received.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring Achieve (HMO C-SNP) plan, which provides no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
HealthSpring Achieve (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services, requiring a copay of $20 per day for days 1 through 20 and $218 per day for days 21 through 100, with no coinsurance. Prior authorization is required for these services, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services offered by HealthSpring Achieve (HMO C-SNP) are partially covered, featuring an $80 quarterly allowance for over-the-counter items and a limited-duration meal benefit with no copay or coinsurance. Acupuncture and Dual Eligible SNP highly integrated services are not covered under this plan.
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