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HealthSpring Preferred Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Preferred Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Preferred Plus (HMO) in 2026, please refer to our full plan details page.
HealthSpring Preferred Plus (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 Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.00. 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 Plus (HMO) 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 service, while standard options require a $10 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, costing as little as a $4 copay for a one-month supply at preferred locations. Tier 3 preferred brand drugs carry a consistent $47 copay for a one-month supply across all pharmacy and mail-order channels. For higher-tier medications, Tier 4 non-preferred drugs require a 50% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. Utilizing preferred network pharmacies and mail-order services is the best way to minimize your out-of-pocket prescription costs with this plan.
Additional Benefits
The HealthSpring Preferred Plus (HMO) plan offers comprehensive medical coverage featuring no copay for primary care visits and a $25 copay for specialist visits, both with no coinsurance. For inpatient hospital stays, members pay a $320 daily copay for the first six days, while emergency room visits require a $115 copay. Additionally, key services like preventive care, home health, and laboratory tests are covered with no copay or coinsurance. Supplemental benefits include dental care with no copay for preventive and comprehensive services up to an annual maximum of $1,100, alongside a $250 annual eyewear allowance with no copay. Routine hearing exams carry a $25 copay, with hearing aids available for copays starting at $399. Members also receive up to 30 one-way trips per year to plan-approved locations and a $25 quarterly allowance for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
HealthSpring Preferred Plus (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $320 copay for days 1 through 6 of acute stays and a $330 copay for days 1 through 6 of psychiatric stays, followed by no copay for days 7 through 90. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred Plus (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a $0 to $325 copay, observation services cost a $325 copay per stay, and substance abuse sessions have a $25 copay, all with no coinsurance.
Partial Hospitalization See details
HealthSpring Preferred Plus (HMO) covers partial hospitalization services with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred Plus (HMO) covers ground ambulance services with a $260 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 30 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred Plus (HMO) covers emergency services with a $115 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance per service, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring Preferred Plus (HMO) features primary care physician services with no copay and no coinsurance, alongside specialist, physical therapy, occupational therapy, and opioid treatment services that carry a $25 copay and no coinsurance. Additional telehealth services are available with a $0 to $25 copay and no coinsurance, while podiatry, chiropractic, psychiatric, and mental health specialty services are not covered.
Preventive Services See details
HealthSpring Preferred Plus (HMO) covers preventive services, including annual physical exams, kidney disease education, fitness benefits, and caregiver support, with no copay and no coinsurance. This benefit is partially covered, as other services such as health education, weight management programs, nutritional benefits, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring Preferred Plus (HMO) hearing services are partially covered, featuring routine hearing exams for a $25 copay and OTC hearing aids for a $399 copay, both with no coinsurance. Prescription hearing aids are also covered with a copay 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
HealthSpring Preferred Plus (HMO) provides partially covered vision services, featuring one routine eye exam per year with a $0 to $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering up to a $250 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
HealthSpring Preferred Plus (HMO) covers Medicare-covered dental services with a $25 copay and no coinsurance. Other preventive and comprehensive dental services, including cleanings, x-rays, implants, and orthodontics, are covered with no copay and no coinsurance up to an annual maximum benefit of $1,100.
Home Infusion bundled Services See details
HealthSpring Preferred Plus (HMO) covers Home Infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B drugs, such as chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
HealthSpring Preferred Plus (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is partially covered by HealthSpring Preferred Plus (HMO) with no copay and a 20% coinsurance, and prior authorization is required. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts from specified manufacturers are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred Plus (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and diagnostic radiological services with no copay and no coinsurance. Diagnostic procedures and tests require no coinsurance and a copay ranging from no copay to $95, while outpatient X-rays have no copay and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
HealthSpring Preferred Plus (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring Preferred Plus (HMO) plan, which includes intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HealthSpring Preferred Plus (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred Plus (HMO) partially covers Other Services, providing over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit includes a maximum coverage limit of $25 every three months.
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