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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 Southwest Ohio/North Kentucky. 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 $2875.00 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 $200. For Tier 1 preferred generics and Tier 2 generics, members pay no copay when using a preferred pharmacy or preferred mail order service. If you use a standard pharmacy or standard mail order, Tier 1 copays range from $5 to $15 and Tier 2 copays range from $10 to $30 depending on the supply. For Tier 3 preferred brand drugs, there is a flat copay of $47 for a one-month supply regardless of whether you use a preferred or standard pharmacy or mail order. Tier 4 non-preferred drugs require a 50% coinsurance across all pharmacy options, while Tier 5 specialty drugs have a 30% coinsurance for a one-month supply. These clear cost-sharing tiers make it easy to estimate your out-of-pocket prescription expenses with this plan.
Additional Benefits
HealthSpring Preferred (HMO) offers comprehensive coverage with no copays for primary care visits, preventive screenings, home health services, and routine dental care up to $3,000 annually. For more intensive care, inpatient hospital stays require a daily copay of $290 for the first six days and no copay thereafter, while specialist visits and Medicare-covered dental services carry a $30 copay. Emergency services are covered with a $150 copay, which is waived if you are admitted to the hospital. Diagnostic lab services and home infusion therapies are available with no copay, though diagnostic procedures and outpatient hospital services may require copays up to $200 or $285 respectively. Standard medical equipment and dialysis services generally require a 20% coinsurance with no copay. Additionally, the plan provides extra value through a quarterly $110 over-the-counter item allowance and up to 50 free one-way trips to approved locations per year with no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $290 copay per day 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, featuring a $0 to $285 copay for outpatient hospital services and no copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $30 copay, while outpatient blood services have no copay, coinsurance, or deductible.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $100 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $245 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 50 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $65 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum benefit with a $150 copay and no coinsurance per service.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, while specialist, occupational therapy, physical therapy, and opioid treatment services require a $30 copay and no coinsurance. Telehealth benefits feature a $0 to $30 copay with no coinsurance, whereas chiropractic, psychiatric, mental health specialty, and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. While a fitness benefit is covered, other supplemental preventive services such as health education, in-home safety assessments, nutritional therapy, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred (HMO), including annual routine exams for a $30 copay and no coinsurance, and OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
HealthSpring Preferred (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $30 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 plan benefit of $3,000 per year.
Home Infusion bundled Services See details
Home infusion bundled services are covered under HealthSpring Preferred (HMO) with no copay, although prior authorization is required. Associated Medicare Part B drugs, 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
Dialysis Services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical Equipment benefits under HealthSpring Preferred (HMO) are partially covered with no copay and a 20% coinsurance, and prior authorization is required. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring Preferred (HMO) with no coinsurance and required prior authorization, though outpatient X-ray services are not covered. Covered benefits include lab services with no copay, diagnostic procedures with a $0 to $200 copay, and therapeutic radiological services with a minimum $85 copay.
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
Cardiac rehabilitation services are covered by HealthSpring Preferred (HMO) with no coinsurance and prior authorization required, although only some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Copayments for these rehabilitation services range from $20 to $30.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a three-day prior hospital stay is not required for admission, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered under HealthSpring Preferred (HMO) as acupuncture is not covered. Covered benefits, which include a meal benefit and up to $110 every three months for over-the-counter (OTC) items, are provided with no copay and no coinsurance.
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