A non-government entity
HealthSpring Alliance (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Alliance (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Alliance (HMO) in 2026, please refer to our full plan details page.
HealthSpring Alliance (HMO) is a HMO 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 Alliance (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 Alliance (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 Alliance (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $28.00. 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 $9200.00 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 Alliance (HMO) plan features a $250 drug deductible and offers cost savings on generic medications. For Tier 1 preferred generics, you will pay no copay at preferred pharmacies or through preferred mail order, compared to a $9 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs cost as low as $4 for a one-month supply at preferred locations, with no copay required for a three-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply across all network pharmacies and mail-order services. For higher-tier medications, you will pay coinsurance rather than a copay, which includes a 50% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply, regardless of whether you use preferred or standard fulfillment options.
Additional Benefits
HealthSpring Alliance (HMO) offers comprehensive healthcare coverage with predictable out-of-pocket costs, featuring no copays and no coinsurance for primary care visits, home health services, and routine preventive care. For specialized medical needs, the plan requires no coinsurance and a range of copays, such as $15 to $55 for specialist visits, $115 for emergency room visits, and a $350 daily copay for the first several days of inpatient hospital stays. Outpatient services are also covered with no coinsurance and copays ranging from no copay up to $450. Members benefit from robust supplemental coverage, including dental services with no copay or coinsurance up to a $5,000 annual limit, and vision services featuring a $200 eyewear allowance with no deductible. Routine hearing exams require a $15 copay, while prescription and over-the-counter hearing aids are covered with copays starting at $399. Additionally, durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
HealthSpring Alliance (HMO) inpatient hospital benefits are partially covered with no coinsurance, requiring prior authorization and a $350 daily copay for days 1-7 of acute stays and days 1-5 of psychiatric stays, with no copay for subsequent days up to day 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Alliance (HMO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $450 for outpatient hospital services and a $450 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copay or coinsurance, while outpatient substance abuse individual and group sessions require a $55 copay.
Partial Hospitalization See details
HealthSpring Alliance (HMO) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
HealthSpring Alliance (HMO) covers ground ambulance services with a $220 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. Transportation services are not covered.
Emergency Services See details
HealthSpring Alliance (HMO) covers emergency services with a $115 copay and urgently needed services with a $40 copay, both featuring no coinsurance and waived copays 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 Alliance (HMO) covers primary care physician services with no copay and no coinsurance, while other services like specialist visits, mental health, and physical therapy require copays ranging from $15 to $55 and no coinsurance. Chiropractic care is only partially covered because routine chiropractic services are not covered, and podiatry services are not covered by the plan.
Preventive Services See details
HealthSpring Alliance (HMO) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are only partially covered; while fitness and caregiver support are included, services like health education, personal emergency response systems, weight management, and alternative therapies are not covered.
Hearing Services See details
HealthSpring Alliance (HMO) covers annual routine hearing exams and fitting evaluations for a $15 copay and no coinsurance. Prescription hearing aids are partially covered up to two per year with copays ranging from $399 to $1,800 and no coinsurance, excluding inner ear, outer ear, and over the ear models, while up to two OTC hearing aids are covered annually for a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring Alliance (HMO), offering one routine eye exam per year with a copay ranging from no copay to $55, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $200 annual maximum benefit for contacts, upgrades, or one pair of frames and lenses.
Dental Services See details
HealthSpring Alliance (HMO) provides partially covered dental services, featuring preventive, diagnostic, periodontic, and adjunctive care with no copay and no coinsurance up to a $5,000 annual maximum. Medicare-covered dental services require a $55 copay and no coinsurance, while restorative, endodontic, implant, prosthodontic, oral surgery, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Alliance (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Alliance (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HealthSpring Alliance (HMO) with no copays and a 20% coinsurance, subject to prior authorization. This benefit is partially covered because diabetic supplies are not covered, though durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes and inserts are covered.
Diagnostic and Radiological Services See details
HealthSpring Alliance (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab services, diagnostic radiological services start with no copay, diagnostic tests range from no copay to a $50 copay, outpatient X-rays require a $40 copay, and therapeutic radiological services have a minimum copay of $85.
Home Health Services See details
HealthSpring Alliance (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Alliance (HMO) covers some cardiac rehabilitation services with no copay, no coinsurance, and prior authorization required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Alliance (HMO) with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by HealthSpring Alliance (HMO), featuring a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $15 every three months for OTC items and access to meals for qualifying medical or chronic conditions.
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