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HealthSpring Preferred GA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Preferred GA (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Preferred GA (HMO) in 2026, please refer to our full plan details page.
HealthSpring Preferred GA (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Georgia. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HealthSpring Preferred GA (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 GA (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 GA (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 $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 $5200.00 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 Preferred GA (HMO) plan features a yearly prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs are available with no copay when using a preferred pharmacy or preferred mail order. For Tier 2 generic drugs, costs are as low as an $8 copay for a one-month supply at preferred locations, and there is no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at both standard and preferred pharmacies. Higher-tier prescriptions require coinsurance rather than a copay, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs carrying a 25% coinsurance for a one-month supply. Choosing standard pharmacies or standard mail-order services will generally result in higher out-of-pocket expenses for your generic medications.
Additional Benefits
The HealthSpring Preferred GA (HMO) plan offers affordable access to essential medical services, featuring a low $5 copay for primary care visits and no copay for Medicare-covered preventive services. For specialized care, members pay a $40 copay for specialists, while inpatient hospital stays require a $340 daily copay for the first six days before transitioning to no copay. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital. This plan also provides valuable supplemental benefits, including comprehensive dental coverage with no copay up to an $850 annual limit, and vision eyewear covered up to $250 annually with no copay. Additionally, routine hearing exams are available for a $25 copay, and members can access home health services, over-the-counter items, and meal benefits with no copays.
Inpatient Hospital See details
HealthSpring Preferred GA (HMO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute care has a $340 daily copay for days 1-6 and no copay for days 7-90 with unlimited additional days, while psychiatric care requires a $345 daily copay for days 1-5 and no copay for days 6-90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred GA (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $345, observation services require a $305 copay per stay, and outpatient substance abuse sessions have a $40 copay.
Partial Hospitalization See details
HealthSpring Preferred GA (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred GA (HMO) covers ground ambulance services with a $260 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
HealthSpring Preferred GA (HMO) covers emergency services with a $130 copay and no coinsurance, which is 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 a $50,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred GA (HMO) covers primary care physician services for a $5 copay and no coinsurance, and specialist, physical therapy, occupational therapy, and speech-language pathology services for a $40 copay and no coinsurance. Additional telehealth, opioid treatment, and other health professional services are available with copays ranging from no copay to $40 and no coinsurance. Some services are covered, but routine and other chiropractic care, individual and group mental health and psychiatric sessions, and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by HealthSpring Preferred GA (HMO), featuring no copay and no coinsurance for Medicare-covered preventive services, kidney disease education, caregiver support, and fitness benefits. An annual physical exam is covered with a $5 copay and no coinsurance, while other services like health education, in-home safety assessments, and nutritional benefits are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred GA (HMO), featuring a $25 copay and no coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays from $399 to $1,800 (excluding inner ear, outer ear, and over the ear types), while OTC hearing aids are covered with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring Preferred GA (HMO) covers routine eye exams with a $0 to $50 copay and no coinsurance, though other eye exam services are not covered. Eyewear, including contact lenses, eyeglasses, frames, and upgrades, is covered with no copay, no coinsurance, and no deductible up to a $250 combined annual maximum.
Dental Services See details
HealthSpring Preferred GA (HMO) covers Medicare-covered dental services with a $40 copay and no coinsurance, subject to prior authorization. Other preventive and comprehensive dental services, including cleanings, exams, and implants, are fully covered with no copay and no coinsurance up to an annual maximum benefit of $850.
Home Infusion bundled Services See details
HealthSpring Preferred GA (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred GA (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Preferred GA (HMO) covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered because durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred GA (HMO) with prior authorization required. Diagnostic procedures and tests carry no coinsurance and a copay of $0 to $225, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HealthSpring Preferred GA (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Preferred GA (HMO) with no coinsurance, a $10 copay, and prior authorization requirements. While some services are covered, specific sub-services including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred GA (HMO) with no coinsurance, requiring a $10 copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred GA (HMO) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $15 of coverage every three months, and the meal benefit is available for members with qualifying chronic or medical conditions.
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