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 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 $400.00 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 $4800.00 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 drug deductible of $400. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a one-month supply at preferred locations, with no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, regardless of whether you use a preferred or standard pharmacy. For higher-tier medications, you will pay a percentage of the drug's cost, which includes a 50% coinsurance for Tier 4 non-preferred drugs and a 28% coinsurance for Tier 5 specialty drugs. Selecting preferred pharmacies and mail-order options is the most effective way to minimize your out-of-pocket prescription costs with this plan.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust medical coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For specialist visits, physical therapy, and Medicare-approved dental care, members pay a standard $30 copay with no coinsurance. Inpatient hospital stays require no coinsurance and a daily copay of $315 for the first five days, while skilled nursing facility stays feature no copay for the first 20 days. This plan also features valuable supplemental benefits, including comprehensive dental coverage up to a $1,000 annual limit and routine eye exams with copays up to $35, plus eyewear covered with no copay up to $175 annually. Emergency care is available with a $125 copay, and the plan provides up to 30 one-way transportation trips to approved medical locations with no copay. Other specialized services, such as dialysis and durable medical equipment, are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $315 copayment for days 1 through 5 of an acute stay and a $325 copayment for days 1 through 5 of a psychiatric stay, with no copayment for days 6 through 90. This benefit is partially covered because 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, offering no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $300, observation services carry a $295 copay per stay, and outpatient substance abuse sessions have a $30 copay, with prior authorization required for several services.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $105.00 copay and no coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $270 copay (no coinsurance) and air ambulance services with a 20% coinsurance (no copay). Transportation benefits are partially covered, providing up to 30 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $125 copay and urgently needed services with a $50 copay, featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $125 copay and no coinsurance, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, speech-language pathology, and opioid treatment require a $30 copay and no coinsurance. Additional telehealth and other healthcare professional services feature no coinsurance and copays ranging from $0 to $30, but chiropractic, podiatry, psychiatric, and mental health specialty services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams, kidney disease education, fitness benefits, and caregiver support, with no copay and no coinsurance. However, this benefit is only partially covered as services such as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers annual hearing exams and fitting evaluations for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800 for up to two aids yearly, though inner ear, outer ear, and over the ear models are not covered. Up to two over-the-counter (OTC) hearing aids are also covered each year for a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), as other eye exam services are not covered. Routine eye exams have a $0 to $35 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $175 yearly maximum benefit.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-approved dental services with a $30 copay and no coinsurance, though prior authorization is required. Other preventive and comprehensive dental services, including cleanings, x-rays, implants, and orthodontics, are covered with no copay and no coinsurance up to a maximum annual benefit of $1,000.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, insulin, and other drugs require a 0% to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under HealthSpring Preferred (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Medical equipment is partially covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, subject to prior authorization. Diabetic supplies are not covered under this plan, and covered diabetic equipment is limited to specified manufacturers.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a copay between $0 and $95. Covered radiological services require prior authorization and feature outpatient X-rays with no copay, diagnostic radiology starting at a $0 copay, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
HealthSpring Preferred (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the HealthSpring Preferred (HMO) require prior authorization with no copay and no coinsurance, but only some services are covered; standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services 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 100-day Medicare benefit period are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, offering a meal benefit for chronic illnesses or home-restricting medical conditions with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other supplemental services are not covered under this plan.
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