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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 Athens. 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 $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 $4400.00 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 (HMO) Medicare plan features a $200 drug deductible and offers competitive prescription drug coverage. For Tier 1 preferred generics, members pay no copay when using preferred retail pharmacies or preferred mail-order services. Tier 2 generic drugs are also highly affordable, costing as little as a $4 copay for a one-month supply at preferred pharmacies, or no copay for a three-month supply filled via preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply at both preferred and standard pharmacies. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 30% coinsurance for a one-month supply. Utilizing preferred network pharmacies is the most effective way to minimize your out-of-pocket costs under this plan.
Additional Benefits
The HealthSpring Preferred (HMO) Medicare Advantage plan provides comprehensive coverage with many services requiring no copay and no coinsurance, including primary care visits, preventive screenings, and home health care. For inpatient hospital stays, members pay a $275 daily copay for the first six days, and specialist visits require a budget-friendly $20 copay. Emergency room care has a $125 copay, which is waived if you are admitted to the hospital within 24 hours. Additional benefits include preventive and comprehensive dental services with no copay up to a $1,450 annual limit, as well as routine eyewear with no copay up to a $300 annual limit. For specialized medical needs, services like dialysis and durable medical equipment require a 20% coinsurance, while skilled nursing facility stays feature no copay for the first 20 days. The plan also covers ground ambulance services with a $190 copay and offers a $50 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute hospital stays with no coinsurance and a $275 daily copay for days 1 through 6, with no copay for additional days. Inpatient psychiatric stays are also covered with no coinsurance and a $300 daily copay for days 1 through 6, though 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 $290 copay for outpatient hospital services, a $290 copay per stay for observation services, and a $20 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $105.00 copay and no coinsurance, though prior authorization is required for these services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $190 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 10 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $125 copay and urgently needed services with a $50 copay, both with no coinsurance and waived copayments if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with a $125 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, therapy services, and opioid treatment require a $20 copay and no coinsurance. Telehealth and other health professional services range from a $0 to $20 copay with no coinsurance, but chiropractic, podiatry, mental health, and psychiatric services are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and screenings for glaucoma and diabetes. Additional preventive benefits are partially covered to include fitness programs and caregiver support, while excluding services like health education, nutritional therapy, and in-home support.
Hearing Services See details
HealthSpring Preferred (HMO) covers annual routine hearing exams and fittings for a $20 copay and no coinsurance, alongside up to two OTC hearing aids per year for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $399 and $1,800 for up to two devices annually, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), as other eye exam services are not covered. Routine eye exams are covered with a $0 to $35 copay, no coinsurance, and no deductible, while eyewear is covered with no copay, no coinsurance, no deductible, and a $300 annual limit.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $20 copay and no coinsurance. Other preventive and comprehensive dental services, including cleanings, x-rays, and restorative care, are covered with no copay and no coinsurance up to a maximum annual benefit of $1,450.
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, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and a 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 (HMO) covers diagnostic and radiological services with prior authorization, offering lab services at no copay and no coinsurance, and diagnostic tests with a copay ranging from $0 to $95 and no coinsurance. Diagnostic radiological services start at a $0 copay with no coinsurance, outpatient X-rays feature no copay but require coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by HealthSpring Preferred (HMO), including intensive cardiac, pulmonary, and supervised exercise therapy (SET) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $214 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, offering a limited-duration meal benefit and a $50 quarterly over-the-counter (OTC) allowance with no copay and no coinsurance. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other miscellaneous services are not covered.
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