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HealthSpring Achieve (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Achieve (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Achieve (HMO C-SNP) in 2026, please refer to our full plan details page.
HealthSpring Achieve (HMO C-SNP) is a HMO C-SNP plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Baltimore. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that HealthSpring Achieve (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HealthSpring Achieve (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthSpring Achieve (HMO C-SNP).
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 Achieve (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $51.00. 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 $7950.00 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 Achieve (HMO C-SNP) prescription drug plan features an annual drug deductible of $250. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail-order service. Standard pharmacies and standard mail-order options for generic drugs incur a one-month copay of $9 for Tier 1 and $15 for Tier 2. For Tier 3 preferred brand drugs, you will pay a flat $47 copay for a one-month supply across all pharmacy and mail-order options. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 30% coinsurance. Select diabetic drugs in Tier 6 are available with a copay as low as $9 at preferred pharmacies and preferred mail-order services.
Additional Benefits
The HealthSpring Achieve (HMO C-SNP) plan offers comprehensive medical coverage featuring no copays for primary care visits and preventive services, while specialist visits require a $35 copay. Inpatient hospital stays require a $305 daily copay for the first five days and no copay for days six through 90, while emergency room visits carry a $115 copay. Outpatient hospital services and home health care are also covered, with home health services requiring no copay or coinsurance. For supplemental care, the plan provides preventive dental services with no copay up to a $5,000 annual limit, alongside routine vision exams and up to $100 for eyewear with no copay. Routine hearing exams require a $20 copay, and prescription hearing aids are covered with copays ranging from $399 to $1,800. Durable medical equipment and dialysis services are also covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
HealthSpring Achieve (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $305 daily 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 Achieve (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $305 copay for outpatient hospital services and a $305 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay or coinsurance, while outpatient substance abuse individual and group sessions require a $35 copay.
Partial Hospitalization See details
HealthSpring Achieve (HMO C-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
HealthSpring Achieve (HMO C-SNP) covers ground ambulance services with a $200 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are not covered under this plan.
Emergency Services See details
HealthSpring Achieve (HMO C-SNP) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both with no coinsurance and with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $115 copay and no coinsurance, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring Achieve (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, whereas specialist, psychiatric, mental health, and therapy services require a $35 copay and no coinsurance. Chiropractic services are partially covered as routine and other chiropractic services are not covered, telehealth ranges from a $0 to $35 copay with no coinsurance, and podiatry services are not covered.
Preventive Services See details
HealthSpring Achieve (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, but exclude health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered by HealthSpring Achieve (HMO C-SNP) with no deductibles and no coinsurance, featuring a $20 copay for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with a copay between $399 and $1,800 and no coinsurance for up to two devices per year, though inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered with a $399 copay and no coinsurance for up to two devices annually.
Vision Services See details
Vision services are partially covered by HealthSpring Achieve (HMO C-SNP), offering one annual routine eye exam with a $0 to $45 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is also covered with no deductible, no copay, and no coinsurance up to a $100 annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by HealthSpring Achieve (HMO C-SNP), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care up to a $5,000 annual limit. While exams, cleanings, fluoride, and periodontics are included, the plan does not cover restorative services, endodontics, prosthodontics, implants, oral surgery, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HealthSpring Achieve (HMO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Achieve (HMO C-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Achieve (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay or coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
HealthSpring Achieve (HMO C-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures have a $0 to $50 copay with no coinsurance, lab and diagnostic radiological services have no copay, outpatient X-rays require a $40 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HealthSpring Achieve (HMO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Achieve (HMO C-SNP) with no coinsurance and a $10 copay, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Achieve (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Achieve (HMO C-SNP) partially covers other services, offering a meal benefit for chronic illnesses or home-confining medical conditions with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other supplemental services are not covered.
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