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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 Albuquerque. This plan received an overall rating of 3 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 $4201.00 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) prescription drug plan features an annual drug deductible of $200. You will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail-order service. For Tier 2 generic drugs, copays start at $4 for a one-month supply, and you can get a three-month supply with no copay through preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs carry a $47 copay for a one-month supply at both standard and preferred pharmacies. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply across all pharmacy networks.
Additional Benefits
HealthSpring Preferred (HMO) offers comprehensive healthcare coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $295 daily copay for the first five days and no copay thereafter, while outpatient hospital services range from no copay up to a $270 copay. Emergency care is available with a $130 copay, and specialist and physical therapy visits require a $30 copay. The plan also features valuable extra benefits, including routine dental care with no copay up to a $1,200 annual limit, and routine vision care with no copay for eyewear up to $250. Hearing exams require a $25 copay, while durable medical equipment and dialysis services carry a 20% coinsurance. Additionally, members can take advantage of up to 40 free one-way transportation trips and an $85 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient hospital services with no coinsurance, requiring a $295 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. 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, including ambulatory surgical center and blood services which feature no copays. Outpatient hospital services require a copay of $0 to $270, observation services have a $270 copay per stay, and outpatient substance abuse sessions have a $30 copay, with prior authorization required for most treatments.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $320 copay and air ambulance services with a 20% coinsurance. Transportation services are partially covered with no copay and no coinsurance for up to 40 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $30 copay and no coinsurance. Telehealth and other healthcare professional services have copays ranging from $0 to $30 with no coinsurance, but podiatry, routine chiropractic, and individual or group mental health and psychiatric sessions are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, glaucoma screenings, and fitness benefits. However, these additional services are only partially covered, as programs like health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management are not covered.
Hearing Services See details
Hearing services under HealthSpring Preferred (HMO) are partially covered, requiring a $25 copay and no coinsurance for annual routine exams and fitting evaluations. Up to two prescription hearing aids are covered yearly with a copay ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over-the-ear models are not covered. Up to two OTC hearing aids are also covered annually with a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), featuring no deductibles and no coinsurance for all covered services. Routine eye exams are covered with a $0 to $30 copay (limited to one per year, as other eye exam services are not covered), and eyewear is covered with no copay up to a $250 annual maximum for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $30.00 copay and no coinsurance, which require prior authorization. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum annual benefit of $1,200.00.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance 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 for these services.
Medical Equipment See details
Medical equipment is partially covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, though prior authorization is required. While durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO) with prior authorization, featuring no copay for lab services and outpatient X-rays. Diagnostic tests and procedures have no coinsurance and a $0 to $25 copay, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
HealthSpring Preferred (HMO) offers coverage for home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Preferred (HMO) with no coinsurance and prior authorization, though only some services are covered as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a daily copay of $10 for days 1 to 20 and $218 for days 21 to 100. Prior authorization is required, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, providing meal benefits and up to $85 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and other additional services are not covered under this benefit.
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