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HealthSpring Preferred Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Preferred Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Preferred Plus (HMO) in 2026, please refer to our full plan details page.
HealthSpring Preferred Plus (HMO) is a HMO 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 Preferred Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.00. 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 $6750.00 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 Plus (HMO) plan features a $250 drug deductible. For Tier 1 preferred generics, you will pay no copay when using preferred pharmacies or preferred mail order services, compared to a $9 copay per month at standard pharmacies. Tier 2 generic drugs cost $4 per month at preferred pharmacies, while standard pharmacies require a $15 monthly copay. Tier 3 preferred brand drugs carry a flat $47 monthly copay across all pharmacy and mail order options. For higher-tier prescriptions, Tier 4 non-preferred drugs require a 50% coinsurance regardless of where you fill your prescription. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The HealthSpring Preferred Plus (HMO) plan offers comprehensive medical coverage with no copay for primary care physician visits and a $30 copay for specialist appointments. For hospital care, inpatient stays require a $275 daily copay for days 1 through 5, with no copay for days 6 through 90, while outpatient hospital services range from no copay up to a $325 copay. Emergency care is available with a $130 copay, which is waived if you are admitted within 24 hours. In addition to basic medical care, the plan provides valuable extra benefits, including up to $2,250 annually for preventive and comprehensive dental services with no copay, and a $250 annual eyewear allowance with no copay. Members also receive up to 24 free one-way transportation trips per year to approved locations and an $80 quarterly allowance for over-the-counter items with no copay. Other essential services like home health care require no copay, while medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
HealthSpring Preferred Plus (HMO) provides partially covered inpatient hospital acute and psychiatric services with no coinsurance, though prior authorization is required. Patients pay a $275 daily copay for days 1 through 5 and no copay for days 6 through 90, while additional days, non-Medicare-covered stays, and acute room upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by HealthSpring Preferred Plus (HMO) with no coinsurance, featuring a $0 to $325 copay for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay and no coinsurance, while outpatient substance abuse sessions carry a $30 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HealthSpring Preferred Plus (HMO) with a $140.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under HealthSpring Preferred Plus (HMO), with ground ambulance services requiring a $245 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred Plus (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, both of which waive the copay 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 Preferred Plus (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapy services, and mental health care require a $30 copay and no coinsurance. Telehealth options are available with a $0 to $30 copay and no coinsurance, though podiatry and chiropractic services are not covered under this plan.
Preventive Services See details
HealthSpring Preferred Plus (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, offering caregiver support and home safety devices, while benefits like fitness programs, health education, weight management, and nutritional counseling are not covered.
Hearing Services See details
HealthSpring Preferred Plus (HMO) covers annual routine hearing exams and fittings for a $30 copay and no coinsurance. Up to two prescription or OTC hearing aids are covered per year with no coinsurance and copays ranging from $399 to $1,800, though prescription devices are partially covered as inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
Vision Services are partially covered by HealthSpring Preferred Plus (HMO), featuring routine eye exams with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contact lenses and one pair of eyeglasses per year, has no copay and no coinsurance under a $250 annual maximum benefit.
Dental Services See details
HealthSpring Preferred Plus (HMO) covers Medicare-covered dental services with a $30.00 copay, no coinsurance, and prior authorization. Other preventive and comprehensive dental services, including cleanings, x-rays, and implants, are covered with no copay and no coinsurance up to a maximum annual benefit of $2,250.
Home Infusion bundled Services See details
HealthSpring Preferred Plus (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B drugs, including chemotherapy and radiation, have no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred Plus (HMO) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HealthSpring Preferred Plus (HMO) partially covers medical equipment with no copay and a 20% coinsurance, requiring prior authorization for most items. Covered services include durable medical equipment, prosthetics, and diabetic therapeutic shoes, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred Plus (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and diagnostic radiological services start at no copay, while diagnostic procedures and tests have a $0 to $50 copay, outpatient X-rays cost a $40 copay, and therapeutic radiological services require a minimum $85 copay.
Home Health Services See details
HealthSpring Preferred Plus (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Preferred Plus (HMO) with no copay and no coinsurance, subject to prior authorization. However, in practice only some services are covered, as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 copayment for days 1 through 20 and a $218 copayment for days 21 through 100 per stay. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred Plus (HMO) partially covers Other Services, offering a meal benefit and up to $80 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and other miscellaneous services are not covered under this benefit.
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