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HealthSpring Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Premier (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Premier (HMO-POS) in 2026, please refer to our full plan details page.
HealthSpring Premier (HMO-POS) is a HMO-POS plan offered by Health Care Service Corporation available for enrollment in 2026 to people living in Salt Lake City. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that HealthSpring Premier (HMO-POS) 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 Premier (HMO-POS).
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 Premier (HMO-POS), 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 $3500.00 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 Premier (HMO-POS) prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail-order services. Tier 2 generic medications are also highly affordable, with a low $4 copay for a one-month supply at preferred pharmacies and no copay for a three-month supply filled via preferred mail order. Higher-tier medications under this plan utilize a mix of flat copayments and coinsurance. Tier 3 preferred brand drugs carry a consistent $47 copay for a one-month supply, while Tier 4 non-preferred drugs require a 50% coinsurance. Specialty drugs in Tier 5 are subject to a 30% coinsurance for a one-month supply across all pharmacy and mail-order options.
Additional Benefits
HealthSpring Premier (HMO-POS) offers comprehensive healthcare coverage with predictable out-of-pocket costs, including no copays for primary care visits and a low $10 copay for specialists. For inpatient hospital stays, members pay a $300 daily copay for the first 5 days, with no copay for days 6 through 90 and no coinsurance. Outpatient services and emergency care are also covered, with emergency room visits requiring a $140 copay that is waived if you are admitted. This plan also features strong supplemental benefits, including preventive and comprehensive dental care with no copay up to a $2,500 annual maximum, and a $350 annual allowance for eyewear with no copay. Additionally, members can take advantage of routine hearing exams for a $10 copay, up to 30 free one-way transportation trips to plan-approved locations, and a $100 quarterly over-the-counter item allowance. Home health services require no copay, while durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HealthSpring Premier (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Premier (HMO-POS) covers outpatient hospital services with a $0 to $300 copay and observation services with a $300 copay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $15 copay and no coinsurance.
Partial Hospitalization See details
HealthSpring Premier (HMO-POS) covers partial hospitalization services with a $130.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring Premier (HMO-POS), featuring a $255 copay and no coinsurance for ground ambulance, and a 20% coinsurance with no copay for air ambulance. Transportation services are partially covered with no copay and no coinsurance for up to 30 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by HealthSpring Premier (HMO-POS) with a $140 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $35 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $140 copay and no coinsurance.
Primary Care See details
HealthSpring Premier (HMO-POS) provides primary care physician services with no copay and no coinsurance, and specialist visits for a $10 copay and no coinsurance. Covered physical, occupational, and speech therapies require a $15 copay and no coinsurance, while psychiatric and mental health services have a $30 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring Premier (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, and other routine screenings. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness and caregiver support, but do 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/dietary benefits, home-based palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, home/bathroom safety, or counseling.
Hearing Services See details
HealthSpring Premier (HMO-POS) provides partially covered hearing services, including routine exams and fittings for a $10 copay and no coinsurance. Prescription and OTC hearing aids are covered with no coinsurance and copays ranging from $399 to $1,800, though prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
HealthSpring Premier (HMO-POS) partially covers vision services, offering routine eye exams with a $0 to $25 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $350 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
HealthSpring Premier (HMO-POS) covers Medicare-covered dental services with a $10 copay and no coinsurance, subject to prior authorization. Preventive and comprehensive dental services, including cleanings, exams, and cosmetic or restorative work, are covered with no copay and no coinsurance up to a $2,500 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Premier (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, are covered with coinsurance ranging from no coinsurance to 20%, with insulin drugs also carrying a $35 copay.
Dialysis Services See details
HealthSpring Premier (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HealthSpring Premier (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered under this plan; diabetic therapeutic shoes and inserts are covered with no copay and 20% coinsurance, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HealthSpring Premier (HMO-POS), though prior authorization is required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $50 copay for diagnostic procedures, while radiological services require a $10 copay for X-rays, no copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home health services are covered under the HealthSpring Premier (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HealthSpring Premier (HMO-POS) with no coinsurance and prior authorization required, though some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require a $25 copay.
Skilled Nursing Facility (SNF) See details
HealthSpring Premier (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copayment for days 1 through 20 and a $214 daily copayment for days 21 through 100. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Premier (HMO-POS) offers coverage for select supplemental services with no copay and no coinsurance, including a meal benefit for qualifying medical conditions and a $100 quarterly over-the-counter (OTC) item allowance. Acupuncture and other additional services are not covered under this benefit.
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