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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 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 $4250.00 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 a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a $9 copay for a one-month supply. Tier 2 generic medications cost as little as a $4 copay for a one-month supply at preferred locations, and you can get a three-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply across all pharmacy and mail-order options. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 50% coinsurance, and Tier 5 specialty drugs require a 33% coinsurance for a one-month supply. Choosing preferred pharmacies and mail-order services with this plan helps maximize your savings on everyday generic medications.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits and a budget-friendly $20 copay for specialists. If you require hospital care, inpatient stays carry a $240 daily copay for the first five days with no copay for days six through ninety, while emergency room visits have a $130 copay. Additionally, members can access routine dental services up to a $3,600 yearly maximum and preventive care with no copay or coinsurance. For specialized needs, the plan provides an annual eyewear allowance of up to $275 and home health services with no copay. Routine hearing exams are available for a $20 copay, though prescription hearing aids and medical equipment like durable medical devices require copays or a 20% coinsurance. To support daily wellness, the plan also includes a meal benefit and a $30 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $240 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as 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, including ambulatory surgical center and blood services at no copay. Outpatient hospital services require a $0 to $300 copay, observation services carry a $300 copay per stay, and outpatient substance abuse sessions have a $20 copay, all with no coinsurance.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring Preferred (HMO), requiring prior authorization for ground ambulance services with a $205 copay and air ambulance services with a 20% coinsurance. While some transportation services are covered, trips to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services have a $130 copay and no coinsurance up to a $50,000 maximum benefit.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapies, and mental health services require a $20 copay and no coinsurance. Additional telehealth benefits range from a $0 to $20 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered with no copay and no coinsurance for fitness benefits and caregiver support, but sub-services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred (HMO), featuring a $20 copay and no coinsurance for annual routine hearing exams and evaluations. OTC hearing aids are covered with a $399 copay and no coinsurance, while 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 prescription models are not covered.
Vision Services See details
HealthSpring Preferred (HMO) provides partially covered vision services, offering one routine eye exam annually with a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $275 annual maximum for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
Dental services are covered by HealthSpring Preferred (HMO), featuring a $20 copay and no coinsurance for Medicare-covered dental services, which require prior authorization. Other preventive and comprehensive dental services are available with no copay and no coinsurance up to a $3,600 yearly maximum.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HealthSpring Preferred (HMO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs are subject to a coinsurance ranging from no coinsurance up to 20%, while Medicare Part B insulin drugs are covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
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 because diabetic supplies are not covered, while durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic procedures and radiological services have copays starting at $0 (up to $50 for tests), while outpatient X-rays require a $35 copay and therapeutic radiological services have a minimum copay of $85.
Home Health Services See details
Home Health Services are covered under the HealthSpring Preferred (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered under the HealthSpring Preferred (HMO) plan with no coinsurance, but only some services are covered for a $25 copay because 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 a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the Medicare-covered 100-day limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services with no copay and no coinsurance, though acupuncture is not covered. Covered benefits include a meal benefit for qualifying medical conditions and a $30 quarterly over-the-counter allowance, both provided with no copay and no coinsurance.
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