A non-government entity
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 Philadelphia. 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 $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 $275.00 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 $5900.00 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 Achieve (HMO C-SNP)
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 Achieve (HMO C-SNP) prescription drug plan features an annual drug deductible of $275. For Tier 1 preferred generic drugs, there is no copay when using a preferred pharmacy or preferred mail order service, while standard options require a $9 copay for a one-month supply. Tier 2 generic medications cost as low as a $4 copay for a one-month supply at preferred pharmacies, or no copay for a three-month supply via preferred mail order. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply across all pharmacy and mail order channels. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs at 50% coinsurance and Tier 5 specialty drugs at 29% coinsurance for a one-month supply. Additionally, Tier 6 select diabetic drugs are covered with a copay starting at $9 for a one-month supply at preferred pharmacies.
Additional Benefits
The HealthSpring Achieve (HMO C-SNP) plan provides comprehensive medical coverage with no copay for primary care visits and a $20 copay for specialist visits. Preventive services, home health care, and diagnostic lab tests are available with no copay or coinsurance, while emergency services carry a $130 copay. For hospital stays, there is no coinsurance, though inpatient acute stays require a $225 daily copay for the first seven days before transitioning to no copay. Additional benefits include preventive dental care with no copay and comprehensive dental coverage up to a $20,000 annual limit. Members also benefit from routine vision care, a $35 quarterly allowance for over-the-counter items, and up to 10 free one-way transportation trips per year to plan-approved locations. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HealthSpring Achieve (HMO C-SNP) with no coinsurance, though prior authorization is required. Acute stays require a $225 daily copay for days 1 to 7 and no copay for days 8 to 90, while psychiatric stays require a $230 daily copay for days 1 to 5 and no copay for days 6 to 90; 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, including ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital services have a copay of $0 to $290, observation services have a $290 copay per stay, and outpatient substance abuse sessions require a $20 copay.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Achieve (HMO C-SNP) with a $140 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HealthSpring Achieve (HMO C-SNP) covers ambulance and transportation services, with prior authorization required. Medicare-covered ground ambulance services carry a $200 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for up to 10 one-way trips per year to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Achieve (HMO C-SNP) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance and 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.
Primary Care See details
HealthSpring Achieve (HMO C-SNP) provides primary care physician services with no copay and no coinsurance, while specialists, therapy, and mental health services require a $20 copay and no coinsurance. Chiropractic services are not covered by the plan, but telehealth benefits are available with copays ranging from $0 to $20 and no coinsurance.
Preventive Services See details
HealthSpring Achieve (HMO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and glaucoma screenings, with no copay and no coinsurance. Additional preventive services are partially covered with no copay or coinsurance, including fitness benefits and home safety modifications up to $1,500 lifetime, while sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services covered by HealthSpring Achieve (HMO C-SNP) include routine exams for a $20 copay and no coinsurance, and OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring Achieve (HMO C-SNP), featuring one routine eye exam per year with a $0 to $20 copay and no deductible or coinsurance, while other eye exam services are not covered. Covered eyewear has no copay, coinsurance, or deductible, providing up to a $100 annual maximum for contact lenses, upgrades, and one pair of eyeglasses per year.
Dental Services See details
HealthSpring Achieve (HMO C-SNP) offers partially covered dental services up to a $20,000 annual limit, with no copay or coinsurance for preventive care and copays ranging from $0 to $675 with no coinsurance for comprehensive care. Medicare-covered dental services require a $20 copay with no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HealthSpring Achieve (HMO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, carry no coinsurance to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Achieve (HMO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical Equipment is partially covered by HealthSpring Achieve (HMO C-SNP) with no copay and a 20% coinsurance, though prior authorization is required. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Achieve (HMO C-SNP) with no coinsurance, although prior authorization is required. There is no copay for lab services and diagnostic radiological services, while outpatient X-rays carry a $25 copay, diagnostic procedures and tests range from $0 to $50, and therapeutic radiological services require a copay of at least $85.
Home Health Services See details
Home Health Services are covered under the HealthSpring Achieve (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Achieve (HMO C-SNP) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HealthSpring Achieve (HMO C-SNP) with no coinsurance, requiring a $10 copay for days 1 to 20 and a $218 copay for days 21 to 100 per stay. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Achieve (HMO C-SNP) offers other services featuring a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, though acupuncture is not covered. Eligible members receive a $35 quarterly OTC allowance and health-related home meals for chronic illnesses or qualifying medical conditions.
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