A non-government entity
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 Washington DC/Delaware. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $7500.00 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:
Sign up for HealthSpring Preferred (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HealthSpring Preferred (HMO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront costs. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic medications cost as low as a $4 copay for a one-month supply at preferred pharmacies, and you can receive a three-month supply with no copay through preferred mail order. Tier 3 preferred brand-name drugs carry a flat $47 copay for a one-month supply across all retail and mail-order pharmacy options. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 33% coinsurance for a one-month supply. This plan offers significant savings on everyday medications, especially when utilizing preferred pharmacies and mail-order services.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay and no coinsurance for primary care doctor visits and preventive services. For specialized medical care, specialist visits require a copay of $35 to $40, while outpatient services range from no copay up to a $295 copay. Inpatient hospital stays require a $295 daily copay for the first six days, with no copay for days 7 through 90 and no coinsurance throughout. Members also benefit from additional services like home health care, over-the-counter items, and dental care up to $1,350 annually with no copay and no coinsurance. Routine hearing and vision exams are covered with low or no copays, and eyewear is covered up to a $150 annual limit with no copay or coinsurance. Skilled nursing facility stays are also covered with no coinsurance, requiring no copay for the first 20 days.
Inpatient Hospital See details
HealthSpring Preferred (HMO) inpatient hospital benefits are partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered. For covered acute and psychiatric stays, there is no coinsurance, with a $295 daily copay for days 1 to 6 and no copay for days 7 to 90.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, featuring a $0 to $295 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and blood services have no copay and no coinsurance, while outpatient substance abuse sessions require a $40 copay and no coinsurance.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance services with a $230 copay for ground transport and a 20% coinsurance for air transport, with prior authorization required. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
Emergency services are covered under HealthSpring Preferred (HMO) with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $115 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, and offers telehealth services with copays from $0 to $40 and no coinsurance. Specialist visits, mental health, psychiatric, and therapy services require copays between $35 and $40 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) preventive services are partially covered with no copay and no coinsurance for covered benefits like annual physical exams, caregiver support, fitness benefits, and kidney disease education. However, many supplemental services are not covered, including health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Hearing services covered by HealthSpring Preferred (HMO) include routine exams and fitting evaluations for a $30 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $399 to $1,800 and no coinsurance for up to two devices per year, excluding inner ear, outer ear, and over the ear models which are not covered. OTC hearing aids are also covered with a $399 copay and no coinsurance.
Vision Services See details
Vision Services are partially covered by HealthSpring Preferred (HMO) with no deductibles, offering routine eye exams with a $0 to $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $150 annual limit, which includes contact lenses, upgrades, and one pair of eyeglasses per year.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $40 copay and no coinsurance, subject to prior authorization. Other preventive and comprehensive dental services, including cleanings, exams, fillings, and orthodontics, are covered with no copay and no coinsurance up to an annual maximum benefit of $1,350.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and other drugs, require no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under HealthSpring Preferred (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
HealthSpring Preferred (HMO) covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered, as durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Lab services have no copay, while outpatient X-rays carry a $35 copay, diagnostic procedures range from no copay up to $50, and therapeutic radiological services require a minimum copay of $85.
Home Health Services See details
HealthSpring Preferred (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred (HMO) covers some Cardiac Rehabilitation Services with no coinsurance and varying copays, though standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. This benefit is partially covered because additional days beyond the Medicare-covered limit are not covered, though prior authorization is required and a three-day prior hospital stay is not.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, offering over-the-counter (OTC) items and health-related meal benefits with no copay and no coinsurance. Acupuncture is not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved