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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 Northwest 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 $6751.00 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 drug deductible of $200. Under this plan, you will enjoy no copay for Tier 1 preferred generic drugs when filled through a preferred pharmacy or preferred mail order service. For Tier 2 generic medications, copays start as low as $5 for a one-month supply at preferred pharmacies, while standard pharmacies charge a $20 copay. Tier 3 preferred brand drugs require a $47 copay for a one-month supply regardless of which pharmacy or mail order option you choose. For more expensive medications, Tier 4 non-preferred drugs have 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 is the most cost-effective way to manage your prescription costs under this plan.
Additional Benefits
HealthSpring Preferred (HMO) provides affordable healthcare coverage with no copay for primary care doctor visits, annual physical exams, and routine preventive services. For specialist visits and physical therapy, members pay a $30 copay with no coinsurance. Inpatient hospital stays require a daily copay of $285 for days 1 to 6 of acute stays and $325 for psychiatric stays, with no copay for subsequent days. This plan also features excellent supplemental benefits, including no copay for preventive and comprehensive dental care up to a $1,450 annual limit, and no copay for eligible eyewear up to a $300 yearly maximum. Additionally, members pay no copay for home health services, routine transportation up to 20 one-way trips, and quarterly over-the-counter items. For services like dialysis, durable medical equipment, and therapeutic radiology, a 20% coinsurance applies.
Inpatient Hospital See details
Inpatient hospital services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $285 daily copay for days 1 to 6 of acute stays and a $325 daily copay for days 1 to 6 of psychiatric stays, with no copays for days 7 to 90. While acute stays offer unlimited additional days, psychiatric stays do not, and neither benefit covers upgrades or non-Medicare-covered stays.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copays. Outpatient hospital services have a copay of $0 to $310, observation services require a $310 copay per stay, and outpatient substance abuse sessions have a $30 copay, with prior authorization required for most services.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with an $80.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $260 copay and no coinsurance, and air ambulance services with no copay and 20% coinsurance, both requiring prior authorization. Transportation services are partially covered with no copay and no coinsurance for up to 20 one-way trips per year to plan-approved locations under prior authorization, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $110 copay and urgently needed services with a $40 copay, both with no coinsurance and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $110 copay and no coinsurance, up to a maximum plan benefit limit of $50,000.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician visits with no copay and no coinsurance, while specialist, occupational therapy, physical therapy, and opioid treatment services require a $30 copay and no coinsurance. Telehealth services feature a $0 to $30 copay and no coinsurance, though chiropractic, podiatry, psychiatric, and mental health specialty services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness and caregiver support, but exclude health education, in-home safety assessments, personal emergency response systems, nutritional therapy, weight management, alternative therapies, adult day health, palliative care, in-home support, telemonitoring, and counseling.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams and evaluations for a $25 copay and no coinsurance, with no deductible. Prescription hearing aids are partially covered with copays ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered, while OTC hearing aids are covered for a $399 copay and no coinsurance.
Vision Services See details
HealthSpring Preferred (HMO) offers partially covered vision services, as other eye exam services are not covered. Routine eye exams are covered with a $0 to $40 copay and no coinsurance, while eligible eyewear is covered with no copay, no coinsurance, and a $300 annual maximum benefit.
Dental Services See details
HealthSpring Preferred (HMO) covers dental services with no copay and no coinsurance for preventive and comprehensive care, including cleanings, implants, and orthodontics, up to a $1,450 annual maximum. Medicare-covered dental services require prior authorization and have a $30 copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance of 0% to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) covers medical equipment with no copay and a 20% coinsurance, subject to prior authorization for durable medical equipment, prosthetics, and diabetic therapeutic shoes. This benefit is partially covered under the plan, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO), offering no copay for lab services and outpatient X-rays, and a copay of $0 to $95 for diagnostic procedures. Diagnostic services require no coinsurance, whereas therapeutic radiological services carry a minimum 20% coinsurance, with prior authorization required for all services.
Home Health Services See details
Home Health Services are covered under the HealthSpring Preferred (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HealthSpring Preferred (HMO) with no coinsurance and a $10 copay, subject to prior authorization. Although some services are covered, standard cardiac, intensive cardiac, pulmonary, 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) stays with no coinsurance, requiring no copay for days 1 through 20 and a $214 copay for days 21 through 100. Prior authorization is required, and while a three-day prior hospital stay is not required, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, offering Over-the-Counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $50 every three months for OTC items, and the meal benefit is available for those with chronic illnesses or medical conditions requiring them to stay home.
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