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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 Central Pennsylvania. 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 a $200.00 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 $6600.00 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) Medicare plan features an annual drug deductible of $200 before coverage begins. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail order services. Tier 2 generic drugs are also highly affordable, costing as little as a $4 copay for a one-month supply at preferred locations, or no copay for a three-month supply via preferred mail order. Brand-name and specialty medications under this plan are subject to set copays or coinsurance. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply across all pharmacy and mail-order options. Tier 4 non-preferred drugs carry a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits and therapies require a $35 copay with no coinsurance, while inpatient hospital stays carry a daily copay of $210 for the first six days followed by no copay. Outpatient hospital services feature no coinsurance and copays ranging from no copay up to $335. Supplemental benefits include dental care with no copay for preventive services and a $20,000 annual maximum, as well as routine vision exams and a $200 yearly eyewear allowance with no copay. Hearing exams feature a $30 copay, and members receive up to $75 every three months for over-the-counter items with no copay. For durable medical equipment and dialysis services, the plan requires a 20% coinsurance with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HealthSpring Preferred (HMO) with no coinsurance, though prior authorization is required and upgrades, additional days, and non-Medicare-covered stays are not covered. For acute stays, there is a $210 daily copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require a $240 daily copay for days 1 through 6 and no copay for days 7 through 90.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital services require a copay of $0 to $335, observation services have a $335 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance services with a $195 copay and applicable coinsurance for ground transport, and a 20% coinsurance plus an applicable copay for air transport. Transportation services are partially covered with no copay or coinsurance for up to 20 one-way trips per year to plan-approved locations, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency services under HealthSpring Preferred (HMO) are covered with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum benefit with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, therapies, and mental health services require a $35 copay and no coinsurance. Chiropractic and podiatry services are not covered, and most specialist services require prior authorization.
Preventive Services See details
Preventive services are partially covered by HealthSpring Preferred (HMO) with no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings. While fitness benefits and caregiver support are covered, several other services—including health education, in-home safety assessments, nutritional therapy, and weight management programs—are not covered.
Hearing Services See details
Hearing services under HealthSpring Preferred (HMO) include annual routine exams and fitting evaluations for a $30 copay and no coinsurance. Prescription and OTC hearing aids are covered for up to two devices per year with no coinsurance and copays ranging from $399 to $1,800, though prescription inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
HealthSpring Preferred (HMO) provides partially covered vision services, offering one routine eye exam per year with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $200 yearly maximum allowance for contacts, upgrades, and one pair of eyeglasses, lenses, or frames.
Dental Services See details
Dental services are partially covered by HealthSpring Preferred (HMO) with an annual maximum benefit of $20,000, offering no copay and no coinsurance for preventive care and copays of $0 to $675 with no coinsurance for comprehensive care. Medicare-covered dental services require a $35 copay with no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have a coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes, all of which require prior authorization. While these services are covered, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO) with no coinsurance, though prior authorization is required. Under this plan, lab services have no copay, while diagnostic procedures range from a $0 to $50 copay, outpatient X-rays carry a $40 copay, 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, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance; however, in practice only some services are covered, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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 copayment for days 1 through 20 and a $218 daily copayment for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
Other Services are partially covered by HealthSpring Preferred (HMO), offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. The plan provides up to $75 every three months for OTC items, and limited-duration meals are covered for chronic illnesses or medical conditions that require the member to remain at home.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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