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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 Lehigh Valley. 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 $5000.00 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 $200 drug deductible before coverage begins. You can enjoy no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, with copays starting at $4 for a one-month supply, or no copay if you choose a three-month supply through preferred mail order. For higher-tier medications, Tier 3 preferred brand drugs carry a consistent $47 copay for a one-month supply at both standard and preferred pharmacies. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply. Utilizing preferred pharmacies and mail-order services is the most cost-effective way to fill your prescriptions under this plan.
Additional Benefits
HealthSpring Preferred (HMO) offers comprehensive medical coverage featuring no copay for primary care visits, while specialist consultations require a $25 copay. Inpatient hospital stays require daily copays of either $135 or $225 for the first six days, followed by no copay for days seven through 90. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. For extra wellness benefits, the plan provides preventive dental care, home health services, and up to 20 one-way transportation trips annually with no copay. Members also benefit from a $125 quarterly over-the-counter allowance and up to $325 per year for eyewear with no copay. Routine hearing exams require a $25 copay, though many specialized services under this plan will require prior authorization.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a daily copay of $135 for acute stays or $225 for psychiatric stays for days 1 through 6, followed by no copay for days 7 through 90. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) outpatient services are covered with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $225, observation services require a $225 copay per stay, and outpatient substance abuse sessions carry a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (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 with no copay or coinsurance for up to 20 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with copays waived if 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 (HMO) covers primary care physician services and select telehealth benefits with no copay and no coinsurance, while specialist visits, therapy, and psychiatric services require a $25 copay and no coinsurance. Chiropractic and podiatry services are not covered, and most specialty care requires prior authorization.
Preventive Services See details
Preventive services are partially covered by HealthSpring Preferred (HMO) with no copay and no coinsurance for covered care, such as annual physical exams, kidney disease education, and glaucoma screenings. While fitness benefits and home safety modifications are included, several supplemental benefits such as health education, weight management, nutritional services, and in-home support are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred (HMO), including annual routine exams and fittings for a $25.00 copay and no coinsurance, and up to two OTC hearing aids per year for a $399.00 copay and no coinsurance. While some prescription hearing aid services are covered with no coinsurance and a copay of $399.00 to $1,800.00, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Preferred (HMO) vision services are partially covered, offering one routine eye exam per year with a $0 to $25 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a combined maximum plan benefit of $325 per year for contacts, eyeglasses, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) partially covers dental services up to a $20,000 annual maximum, featuring preventive care with no copay and no coinsurance, and Medicare-covered dental with a $25 copay and no coinsurance. Comprehensive services have copays ranging from $0 to $675 and 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 and step therapy are required. Covered Medicare Part B insulin drugs have a $35 copay, while chemotherapy and other Part B drugs range from no coinsurance 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) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though prior authorization is required. This benefit is partially covered, as diabetic supplies are not covered and diabetic equipment is limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO) with no coinsurance, though prior authorization is required. There is no copay for lab services, while diagnostic procedures and tests cost between $0 and $60, outpatient X-rays have 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Preferred (HMO) with no coinsurance, but in practice only some services are covered because 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, and while a prior three-day inpatient hospital stay is not necessary, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, though acupuncture is not covered. The OTC benefit provides up to $125 in coverage every three months, while the meal benefit is available to members with qualifying chronic or medical conditions.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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