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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 Northeast Ohio. 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 $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 $6750.00 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 $400. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for up to a three-month supply when filling prescriptions through preferred pharmacies or preferred mail-order services. Standard pharmacies and standard mail-order options are also available, with copays starting at $5 for Tier 1 and $10 for Tier 2. For brand-name and specialty medications, Tier 3 preferred brand drugs require a $47 copay for a one-month supply across all pharmacy types. Tier 4 non-preferred drugs are covered with a 50% coinsurance, and Tier 5 specialty drugs require a 28% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and annual physicals. For inpatient hospital stays, members pay a daily copay of $365 for days one through six, after which there is no copay, while specialist visits and Medicare-covered dental care require a $30 copay. Emergency care carries a $130 copay that is waived upon admission, and outpatient hospital services range from no copay up to a $310 copay. Additional benefits include routine dental services with no copay up to a $20,000 annual maximum, routine vision exams starting with no copay, and routine hearing exams for a $25 copay. However, members should expect a 20% coinsurance for services such as dialysis, medical equipment, and Medicare Part B drugs. It is also important to note that certain benefits, including over-the-counter items, acupuncture, and routine transportation, are not covered under this plan.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $365 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay. Outpatient hospital services require a $0 to $310 copay, observation services have a $310 copay per stay, and outpatient substance abuse sessions carry a $30 copay, all with no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the HealthSpring Preferred (HMO) plan with a $100 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring Preferred (HMO), requiring a $225 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Prior authorization is required for ambulance services, and transportation services to health-related locations are 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 require 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) covers 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. Some psychiatric and mental health services are covered with no copay and no coinsurance, but individual and group sessions are not covered, and chiropractic and podiatry services are also excluded.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams, kidney disease education, and a fitness benefit, with no copay and no coinsurance. However, additional preventive benefits are only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, bathroom safety, and counseling are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams for a $25 copay and OTC hearing aids for a $399 copay, both with no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800, excluding inner ear, outer ear, and over-the-ear prescription hearing aids which are not covered.
Vision Services See details
Vision services under HealthSpring Preferred (HMO) are partially covered, offering one routine eye exam per year with no coinsurance and a copay ranging from no copay to $30. Other eye exam services and eyewear, including eyeglasses and contact lenses, are not covered.
Dental Services See details
Dental services are partially covered by HealthSpring Preferred (HMO), offering Medicare-covered dental care with a $30 copay and no coinsurance, plus other covered preventive and comprehensive services with no copay and no coinsurance up to a $20,000 yearly maximum. Sub-services that are not covered under this plan include maxillofacial prosthetics, implant services, fixed prosthodontics, and orthodontics.
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, including chemotherapy, radiation, and insulin, carry a 0% to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered because diabetic therapeutic shoes and inserts are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Under this plan, lab services and diagnostic radiological services have no copay, while outpatient X-rays cost $40, therapeutic radiology has a minimum $85 copay, and diagnostic procedures and tests carry a copay of $0 to $200.
Home Health Services See details
HealthSpring Preferred (HMO) covers home health services 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, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, and SET for PAD services (each with a $25 copay) as well as pulmonary rehabilitation services (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100 per stay. This benefit is partially covered, as prior authorization is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the HealthSpring Preferred (HMO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded. Because these services are not covered, there are no copays or coinsurance benefits available for them.
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