A non-government entity
HealthSpring Preferred PA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Preferred PA (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Preferred PA (HMO) in 2026, please refer to our full plan details page.
HealthSpring Preferred PA (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 PA (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 PA (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 PA (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 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 $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:
Sign up for HealthSpring Preferred PA (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 PA (HMO) plan features a $275 annual drug deductible and offers cost-saving opportunities on generic medications. For Tier 1 preferred generics, 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 generics are also highly affordable, starting at a $4 copay for a one-month supply at preferred pharmacies and featuring no copay for a three-month supply through preferred mail order. For brand-name and specialty medications, the cost-sharing transitions to set copays and coinsurance rates. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply across all pharmacy and mail-order options. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring 29% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred PA (HMO) plan offers comprehensive medical coverage with predictable cost-sharing, featuring no copay for primary care physician visits, annual physicals, and home health services. For specialists, physical therapy, and routine hearing exams, members typically pay a low $25 copay. Inpatient hospital stays require a $395 daily copay for the first five days, after which there is no copay, while emergency room visits carry a $130 copay that is waived if admitted. This plan also includes valuable dental, vision, and hearing benefits, such as no copay for preventive dental care and up to a $250 annual allowance for eyewear with no copay. For specialized needs, diagnostic lab services require no copay, while durable medical equipment, prosthetics, and dialysis services are covered with a 20% coinsurance and no copay. Additionally, members can take advantage of an over-the-counter item allowance of up to $80 every three months with no copay.
Inpatient Hospital See details
HealthSpring Preferred PA (HMO) covers inpatient acute hospital stays with no coinsurance and a $395 daily copay for days 1 to 5, followed by no copay for days 6 to 90. Inpatient psychiatric care is also covered with no coinsurance and a $324 daily copay for days 1 to 5, then no copay for days 6 to 90, though both benefits require prior authorization and do not cover upgrades, additional days, or non-Medicare stays.
Outpatient Services See details
HealthSpring Preferred PA (HMO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $450 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while individual and group outpatient substance abuse sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
HealthSpring Preferred PA (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred PA (HMO) covers ground ambulance services with a $220 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 10 one-way trips per year to plan-approved locations with no copay and no coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
HealthSpring Preferred PA (HMO) covers emergency services with a $130 copay and urgently needed care with a $50 copay, with no coinsurance for either service and copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred PA (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical/occupational therapy, and mental health services generally require a $25 copay and no coinsurance. Telehealth benefits are covered with a $0 to $25 copay and no coinsurance, though podiatry and routine chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the HealthSpring Preferred PA (HMO) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and glaucoma screenings. While caregiver support and home safety modifications (up to a $1,500 lifetime limit) are covered, sub-services such as health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, smoking cessation, fitness, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
HealthSpring Preferred PA (HMO) covers annual routine hearing exams and fittings for a $25 copay and no coinsurance, alongside up to two OTC hearing aids per year 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 hearing aids are not covered.
Vision Services See details
HealthSpring Preferred PA (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $25 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, has no copay, no coinsurance, and no deductible, up to a $250 annual maximum.
Dental Services See details
HealthSpring Preferred PA (HMO) provides partially covered dental services, featuring no copay and no coinsurance for preventive care and a $25 copay with no coinsurance for Medicare-covered dental. Comprehensive dental services are covered with no coinsurance and copays ranging from $0 to $675, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred PA (HMO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Preferred PA (HMO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical Equipment is partially covered by HealthSpring Preferred PA (HMO), offering covered items like durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance. Prior authorization is required for these services, and diabetic supplies are not covered by the plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred PA (HMO) with no coinsurance, though prior authorization is required. Members pay no copay for lab services and diagnostic radiology, while diagnostic procedures and tests cost between $0 and $50, outpatient X-rays have a $40 copay, and therapeutic radiological services require a minimum copay of $85.
Home Health Services See details
Home Health Services are covered under the HealthSpring Preferred PA (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HealthSpring Preferred PA (HMO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred PA (HMO) 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 for these services, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred PA (HMO) partially covers other services with no copay and no coinsurance, offering meal benefits for chronic illnesses and up to $80 every three months for over-the-counter items. Acupuncture is not covered under this plan.
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