A non-government entity
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 West Metro Atlanta. 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 $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 $6950.00 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:
Sign up for HealthSpring Preferred (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HealthSpring Preferred (HMO) plan features an annual prescription 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, compared to a $10 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs are also highly affordable, with a $5 copay for a one-month supply at preferred pharmacies and preferred mail order. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply across all pharmacy and mail-order channels. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 25% coinsurance. Utilizing preferred pharmacies and preferred mail-order options can significantly lower your out-of-pocket prescription costs with this plan.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust medical coverage with no copay for primary care doctor visits and a $45 copay for specialist visits. For hospital stays, members pay a $315 daily copay for the first seven days of inpatient care and no copay for days eight through 90. Emergency room visits require a $115 copay, which is waived if you are admitted, while urgently needed care carries a $40 copay. Routine dental and vision care are highly affordable, featuring no copay alongside an annual $850 dental limit and a $150 eyewear allowance. Hearing services are also covered, including routine exams with a $20 copay and prescription hearing aids starting at a $399 copay. Additionally, diagnostic lab work and home health services require no copay, while durable medical equipment and dialysis services generally carry a 20% coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, you pay a $315 daily copay for days 1-7 and no copay for days 8-90 with unlimited additional days, while psychiatric stays cost a $325 daily copay for days 1-6 and no copay for days 7-90; however, 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, featuring a $0 to $325 copay for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copay or coinsurance, while outpatient substance abuse services carry a $45 copay per session.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $105.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by HealthSpring Preferred (HMO), though transportation to health-related locations is not covered. Covered ground ambulance services require a $250 copay and coinsurance, while air ambulance services require a 20% coinsurance and a copay, with prior authorization required for both.
Emergency Services See details
Emergency services are covered by HealthSpring Preferred (HMO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Physical, occupational, and speech therapies require a $35 copay and no coinsurance, while chiropractic, podiatry, mental health, and psychiatric services are not covered.
Preventive Services See details
Preventive Services are partially covered under HealthSpring Preferred (HMO) with no copays and no coinsurance for covered benefits like annual physical exams, fitness benefits, caregiver support, and kidney disease education. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, weight management programs, and nutritional benefits.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams and fitting evaluations with a $20 copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no coinsurance and a copay of $399 to $1,800 for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered with a $399 copay and no coinsurance for up to two devices yearly.
Vision Services See details
Vision Services under HealthSpring Preferred (HMO) are partially covered, offering one routine eye exam every year with a $0 to $55 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $150 annual maximum for contacts, upgrades, or one pair of eyeglasses.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $45 copay and no coinsurance, which require prior authorization. Other preventive and comprehensive dental services, such as cleanings, x-rays, and implants, are covered with no copay and no coinsurance up to a maximum annual benefit of $850.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require a coinsurance ranging from no coinsurance up to 20%, with insulin specifically carrying a $35 copay.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HealthSpring Preferred (HMO) with prior authorization, featuring no copay for lab services and outpatient X-rays. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $95, while diagnostic radiological services carry a minimum $0 copay and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
HealthSpring Preferred (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 covered by HealthSpring Preferred (HMO) with no coinsurance and a $10 copay, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a daily copay of $218 for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, offering a meal benefit and a $35 quarterly over-the-counter (OTC) allowance with no copay and no coinsurance. Acupuncture is not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved