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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 2026 to people living in St. Louis. 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 $2300.00 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 an annual drug deductible of $200. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order service, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic prescription drugs cost as little as a $4 copay for a one-month supply at preferred pharmacies, and a three-month supply via preferred mail order has no copay. Tier 3 preferred brand-name drugs require a flat $47 copay for a one-month supply across all pharmacy and mail order options. For higher-tier medications, the plan charges a 50% coinsurance for Tier 4 non-preferred drugs and a 30% coinsurance for Tier 5 specialty drugs. These structured copays and coinsurance rates help HealthSpring Preferred (HMO) members manage their prescription medication costs effectively throughout the year.
Additional Benefits
The HealthSpring Preferred (HMO) Medicare plan offers comprehensive medical coverage with affordable out-of-pocket costs, including no copay for primary care visits and no coinsurance for most services. Specialist visits, physical therapy, and Medicare-covered dental services require a low copay of $20, while emergency room visits have a $150 copay that is waived if you are admitted. For hospital stays, inpatient acute care requires a $190 daily copay for the first seven days, with no copay for subsequent days. This plan also features strong supplemental benefits, such as preventive and comprehensive dental care with no copay up to a $3,300 annual limit, and no copay for eyewear up to a $300 yearly maximum. Additionally, members benefit from a quarterly $115 over-the-counter allowance, no copay for home health services, and a 20% coinsurance for durable medical equipment. While many services like diagnostic tests and specialized outpatient care require prior authorization, they feature low copays and no coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient hospital services with no coinsurance, though prior authorization is required, and non-Medicare-covered stays and upgrades are not covered. Acute stays require a $190 daily copay for days 1 to 7 with no copay for subsequent days, while psychiatric stays require a $205 daily copay for days 1 to 7 and no copay for days 8 to 90.
Outpatient Services See details
Outpatient services are covered by HealthSpring Preferred (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $190, observation services carry a $190 copay per stay, and outpatient substance abuse sessions require a $20 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $100 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance services with a $230 copay (no coinsurance) for ground transport and a 20% coinsurance (no copay) for air transport, with prior authorization required. Transportation services are partially covered, providing up to 20 one-way trips per year to plan-approved locations with no copay or coinsurance, though trips to any health-related location are not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $150 copay and urgently needed services with a $65 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 plan maximum with a $150 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care services with no copay and no coinsurance, while specialist, therapy, and opioid treatments require a $20 copay and no coinsurance. Some telehealth, chiropractic, mental health, and psychiatric services are covered with copays ranging from $0 to $20 and no coinsurance, but podiatry, routine or other chiropractic care, and individual or group sessions for mental health and psychiatry are not covered.
Preventive Services See details
Preventive services under HealthSpring Preferred (HMO) are partially covered with no copay and no coinsurance for annual physicals, fitness benefits, caregiver support, and kidney education. Supplemental services including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and nutritional or dietary benefits are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers annual routine hearing exams and fittings for a $20 copay and no coinsurance. Hearing aids are partially covered up to two per year with no coinsurance, requiring a $399 copay for OTC models and a $399 to $1,800 copay for prescription models, though inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
HealthSpring Preferred (HMO) partially covers vision services, offering routine eye exams with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $300 annual maximum benefit for contacts, eyeglasses, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $20 copay and no coinsurance, though prior authorization is required. Comprehensive and preventive dental services, including cleanings, x-rays, and restorative care, are covered with no copay and no coinsurance up to an annual maximum benefit of $3,300.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HealthSpring Preferred (HMO) with no copay, though prior authorization is required. Medicare Part B drugs associated with these services, 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
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered under HealthSpring Preferred (HMO) with no copay and 20% coinsurance for durable medical equipment and prosthetics, both requiring prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization, offering no coinsurance and a $0 to $25 copay for diagnostic tests, alongside no copay for lab services. Outpatient X-rays have no copay, diagnostic radiological services feature copays starting at $0, 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred (HMO) covers Cardiac Rehabilitation Services with no copay and no coinsurance, meaning some services are covered, although cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $20 copay per day for days 1 to 20 and a $218 copay per day for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required for admission, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other services are partially covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, featuring a meal benefit and up to $115 every three months for over-the-counter items. Acupuncture and other additional services under this benefit are not covered.
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