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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 $30.00. 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 $6800.00 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) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order. Tier 2 generic drugs start at 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. For Tier 3 preferred brand drugs, members pay a flat $47 copay for a one-month supply across all pharmacy and mail order options. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 25% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred GA (HMO) plan offers affordable coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance but will face a daily copay of $340 for the first six days of acute care. Outpatient services and emergency care are also covered, with emergency visits requiring a $115 copay that is waived if you are admitted. This plan provides valuable supplemental benefits, including routine dental and eyewear coverage with no copay up to specified annual limits, alongside hearing aid coverage with copays. Many diagnostic services like lab tests and X-rays are available with no copay, while specialized services such as dialysis and medical equipment require a 20% coinsurance. Skilled nursing facility stays are also covered with no copay for the first 20 days.
Inpatient Hospital See details
HealthSpring Preferred GA (HMO) covers inpatient hospital services with no coinsurance, requiring a $340 daily copay for days 1 through 6 of acute stays and a $370 daily copay for days 1 through 5 of psychiatric stays. While there is no copay for subsequent days and unlimited additional acute days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered under the HealthSpring Preferred GA (HMO) with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services require a copay of $0 to $365, observation services cost a $325 copay per stay, and substance abuse sessions carry a $50 copay, with prior authorization required for most services.
Partial Hospitalization See details
HealthSpring Preferred GA (HMO) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred GA (HMO) covers ground ambulance services with a $235 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services are not covered under this plan.
Emergency Services See details
HealthSpring Preferred GA (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred GA (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, therapies, and telehealth services require prior authorization with copays ranging from $0 to $50 and no coinsurance. Chiropractic, podiatry, mental health, and psychiatric specialty services are not covered under this plan.
Preventive Services See details
HealthSpring Preferred GA (HMO) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive services are only partially covered, with fitness benefits and caregiver support included, while services such as health education, personal emergency response systems (PERS), and nutritional/dietary benefits are not covered.
Hearing Services See details
HealthSpring Preferred GA (HMO) covers annual routine hearing exams and fittings for a $20 copay and no coinsurance. Hearing aid benefits are partially covered with no coinsurance, featuring a $399 copay for up to two OTC devices per year and a $399 to $1,800 copay for up to two prescription hearing aids, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
HealthSpring Preferred GA (HMO) offers partially covered vision services, including routine eye exams with a $0 to $50 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering a $250 annual maximum benefit for contacts, frames, and lenses.
Dental Services See details
HealthSpring Preferred GA (HMO) covers Medicare-covered dental services with a $50 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a $550 annual maximum. Prior authorization is required for Medicare-covered dental services.
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 require 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
Dialysis Services are covered by HealthSpring Preferred GA (HMO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
HealthSpring Preferred GA (HMO) partially covers medical equipment with no copay and 20% coinsurance, with prior authorization required. While durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred GA (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays at no copay. Diagnostic procedures and tests carry no coinsurance with copays ranging from no copay up to $225, while diagnostic radiology starts at no copay and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
HealthSpring Preferred GA (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred GA (HMO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. However, specific programs including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred GA (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Other Services are partially covered by HealthSpring Preferred GA (HMO), which includes over-the-counter (OTC) items with no copay and no coinsurance up to a $15 maximum benefit every three months. Acupuncture, meal benefits, and other additional services are not covered.
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