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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 Colorado. 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 $250.00 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 $4700.00 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 a drug deductible of $250 and provides competitive cost-sharing options. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs are also highly affordable, costing just a $4 copay for a one-month supply at preferred pharmacies and no copay for a three-month supply ordered through preferred mail. Brand-name and specialty medications under this plan are subject to copays or coinsurance. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply at any standard or preferred pharmacy. High-tier prescriptions are covered via coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care visits, annual physical exams, and home health services. For specialized care, members pay a $35 copay for specialist visits and a $130 copay for emergency services, which is waived upon hospital admission. Inpatient hospital stays require a daily copay for the first several days, after which there is no copay for the remainder of your stay. This plan also includes valuable supplemental benefits, such as preventive dental care and routine eyewear covered with no copay up to specified annual limits. Hearing exams and hearing aids are partially covered with copays, while diagnostic lab services feature no copay. Additionally, medical equipment and dialysis services are covered with a 20% coinsurance, and prior authorization is required for several specialized services.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HealthSpring Preferred (HMO) with no coinsurance, though prior authorization is required. For acute stays, there is a $290 daily copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require a $355 daily copay for days 1 through 5 and no copay for days 6 through 90. 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 outpatient hospital services with a $0 to $325 copay and observation services with a $325 copay per stay. Ambulatory surgical center and outpatient blood services feature no copay, while outpatient substance abuse individual and group sessions require a $40 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under HealthSpring Preferred (HMO) with a $60.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. 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, and urgently needed services with a $35 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum benefit with a $130 copay and no coinsurance per service.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $35 copay and no coinsurance. Mental health, psychiatric, and opioid treatments have a $40 copay and no coinsurance, whereas telehealth services require a $0 to $35 copay with no coinsurance, and chiropractic and podiatry are not covered.
Preventive Services See details
Preventive services are partially covered by HealthSpring Preferred (HMO) with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, and fitness programs. However, multiple additional services, including health education, weight management, and in-home safety assessments, are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred (HMO), including annual routine exams and fitting evaluations for a $30 copay and no coinsurance. Prescription hearing aids are partially covered, with copays ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over the ear models are not covered. Over-the-counter hearing aids are covered with a $399 copay and no coinsurance for up to two devices per year.
Vision Services See details
HealthSpring Preferred (HMO) offers partially covered vision services, featuring one routine eye exam per year with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $125 annual maximum for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are covered by HealthSpring Preferred (HMO), which offers Medicare-covered dental care for a $35 copay and no coinsurance. Other preventive and comprehensive dental services, such as cleanings and exams, are covered with no copay and no coinsurance up to a $500 annual maximum.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, have 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
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. Covered items include durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic lab services feature no copay or coinsurance, while diagnostic procedures and tests range from a $0 to $145 copay with no coinsurance. For radiological services, outpatient X-rays require a $5 copay and coinsurance, diagnostic radiology has a minimum $5 copay, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under HealthSpring Preferred (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring Preferred (HMO) plan, meaning there is no coverage, copays, or coinsurance for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services.
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 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $15 every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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