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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 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 $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:
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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, while standard options require a $10 copay for a one-month supply. Tier 2 generic medications cost as low as a $5 copay for a one-month supply at preferred locations, and there is no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply across all pharmacy and mail order options. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 28% coinsurance for a one-month supply. Understanding these tier-based copays and coinsurance rates can help you estimate your annual out-of-pocket prescription costs with this plan.
Additional Benefits
The HealthSpring Preferred (HMO) Medicare plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. Specialist visits, physical therapy, and occupational therapy require a $35 copay with no coinsurance. For hospital stays, members pay a $370 daily copay for the first few days of inpatient care and no copay for subsequent days, while outpatient hospital services range from no copay to a $360 copay. This plan also features valuable additional benefits, including preventive and comprehensive dental care with no copay up to an $800 annual limit. Routine vision exams and eyewear are covered with no copay and a $300 annual maximum, while routine hearing exams require a $25 copay. Additionally, members can access up to 30 free one-way transportation trips per year to plan-approved locations with no copay or coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $370 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays. Prior authorization is required, and there is no copay for subsequent days, 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 no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $360, observation services have a $360 copay per stay, and outpatient substance abuse sessions have a $35 copay.
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 $300 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 30 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under HealthSpring Preferred (HMO) are covered with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require 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) offers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $35 copay and no coinsurance. Telehealth and other health professional services feature copays ranging from $0 to $35 with no coinsurance, though podiatry, routine chiropractic, and individual or group mental health and psychiatric sessions are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) preventive services are covered with no copay and no coinsurance, including annual physical exams, fitness benefits, caregiver support, and kidney disease education. However, this benefit is only partially covered as health education, in-home safety assessments, PERS, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, smoking cessation, enhanced disease management, telemonitoring, remote access, home/bathroom safety devices, and counseling are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers annual routine hearing exams and fittings with a $25 copay and no coinsurance. Prescription hearing aids are partially covered with copays from $399 to $1,800 and no coinsurance for up to two devices annually, excluding inner ear, outer ear, and over the ear models, while up to two OTC hearing aids are covered with 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 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 maximum limit.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $35 copay and no coinsurance, and offers other preventive and comprehensive dental services with no copay and no coinsurance. These additional dental services, including exams, cleanings, and orthodontics, are covered up to an annual maximum benefit of $800.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HealthSpring Preferred (HMO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a 0% to 20% coinsurance, while Medicare Part B insulin has a $35 copay and 0% to 20% coinsurance.
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 this benefit.
Medical Equipment See details
Medical equipment is covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, subject to prior authorization requirements. This benefit is partially covered because diabetic supplies are not covered, and covered diabetic equipment is limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO) subject to prior authorization, offering no copay for lab services and outpatient X-rays. Diagnostic procedures and tests feature no coinsurance and a copay of $0 to $95, while diagnostic radiological services have a minimum $0 copay 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
HealthSpring Preferred (HMO) covers Cardiac Rehabilitation Services with no coinsurance and a $10 copay, requiring prior authorization. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no preceding three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 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, providing over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $15 every three months. Acupuncture, meal benefits, and dual-eligible SNP services are not covered.
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