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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 Northeast Georgia. 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 $4950.00 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)
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Drug Coverage
The HealthSpring Preferred (HMO) plan features a $200 prescription drug deductible. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail-order services, while standard pharmacies require a $10 monthly copay. Tier 2 generic drugs cost as little as a $4 copay for a one-month supply at preferred pharmacies, compared to a $20 copay at standard pharmacies. For brand-name and specialty medications, Tier 3 preferred brand drugs carry a $47 monthly copay across all pharmacy options. Tier 4 non-preferred drugs require a 50% coinsurance, and Tier 5 specialty drugs require a 30% coinsurance for a one-month supply. Utilizing preferred network pharmacies and mail-order services provides the lowest out-of-pocket costs under this plan.
Additional Benefits
HealthSpring Preferred (HMO) provides comprehensive medical coverage, featuring no copay for primary care visits and no coinsurance for inpatient or outpatient hospital stays. While specialist visits require a $25 copay, emergency services are covered with a $125 copay, which is waived if you are admitted. Covered hospital stays involve daily copays for the first few days, after which there is no copay for the remainder of your stay. The plan also offers valuable everyday benefits, including preventive and comprehensive dental care with no copay up to a $1,450 annual limit, and a $300 yearly allowance for eyewear with no copay. Additionally, members can access up to 30 one-way transportation trips per year and receive a $70 quarterly allowance for over-the-counter items, both with no copay or coinsurance. Routine hearing exams and hearing aid coverage are also available with affordable copays and no deductible to help manage your out-of-pocket costs.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. For acute stays, you pay a $320 daily copay for days 1 to 7 and no copay for days 8 and beyond, whereas psychiatric stays require a $325 daily copay for days 1 to 6 and no copay for days 7 to 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 copays ranging from $0 to $330 for outpatient hospital services and $315 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $25 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $105.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 30 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $125 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum plan benefit, with a $125 copay and no coinsurance per service.
Primary Care See details
Primary care benefits under HealthSpring Preferred (HMO) include primary care physician visits with no copay and no coinsurance, while specialist and therapy services require a $25 copay and no coinsurance. Podiatry is not covered, and chiropractic, mental health, and psychiatric services are covered but exclude routine, individual, and group sessions.
Preventive Services See details
Preventive services are partially covered under HealthSpring Preferred (HMO) with no copay and no coinsurance for covered benefits like annual physical exams and fitness benefits. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, or counseling services.
Hearing Services See details
HealthSpring Preferred (HMO) covers hearing services with no deductible, including annual routine exams and fittings for a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a $399 to $1,800 copay for up to two devices yearly, excluding inner ear, outer ear, and over the ear models. Up to two OTC hearing aids are also covered annually with a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), offering routine eye exams with a $0 to $35 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $300 annual maximum limit for contacts, lenses, frames, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $25 copay and no coinsurance, which require prior authorization. Other preventive and comprehensive dental services, including exams, cleanings, and reconstructive services, 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. Covered Medicare Part B drugs, including chemotherapy, radiation, and other drugs, have no copay and coinsurance ranging from no coinsurance up to 20%, while insulin has a $35 copay and coinsurance ranging from no coinsurance up to 20%.
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, requiring prior authorization for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are not covered under this benefit, and covered diabetic equipment is limited to specified manufacturers.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay and no coinsurance. Diagnostic tests feature no coinsurance and a copay of $0 to $95, while diagnostic radiological services have a minimum $0 copay, outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
HealthSpring Preferred (HMO) provides coverage for home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred (HMO) covers Cardiac Rehabilitation Services with prior authorization, no coinsurance, and a $10 copay, though only some services are covered in practice. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, and prior authorization is required. There is no copay for days 1 through 20, followed by a $214 daily copay for days 21 through 100 per stay, though additional days beyond the Medicare limit are not covered.
Other Services See details
Other services are partially covered by HealthSpring Preferred (HMO), which offers a meal benefit and up to $70 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and certain other services under this benefit category are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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