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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 Western 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 $4000.00 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 prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, you pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic drugs cost $4 for a one-month supply at preferred pharmacies and feature no copay for a three-month supply ordered through preferred mail-order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at both preferred and standard pharmacies. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 50% coinsurance, and Tier 5 specialty drugs require a 30% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, home health care, and core preventive services. Specialists and routine diagnostic services generally require a low copay, while inpatient hospital stays incur daily copays for the first five days before transitioning to no copay for longer stays. Emergency services are covered with a flat copay and no coinsurance, which is waived if you are admitted to the hospital. Members also benefit from comprehensive dental and vision care, featuring no copay for preventive dental exams and routine eye exams, alongside allowance benefits for eyewear. Hearing exams and hearing aids are covered under predictable copays with no coinsurance, while medical equipment and dialysis services generally require a twenty percent coinsurance. Additionally, the plan includes extra perks like a quarterly over-the-counter allowance and home meal deliveries at no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HealthSpring Preferred (HMO) with no coinsurance, though prior authorization is required. For acute stays, there is a $140 daily copay for days 1-5 and no copay for days 6-90, while psychiatric stays require a $175 daily copay for days 1-5 and no copay for days 6-90; additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, although prior authorization is required for several benefits. Covered services feature no copay for ambulatory surgical center and blood services, a $20 copay for substance abuse sessions, and copays ranging from $0 to $175 for outpatient hospital and observation services.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $175.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $230 copay (no coinsurance) and air ambulance services with a 20% coinsurance (no copay), both requiring prior authorization. Transportation services are partially covered with no copay or 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 Preferred (HMO) covers emergency services with a $150 copay and urgently needed services with a $65 copay, both featuring no coinsurance and copay waivers if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring Preferred (HMO) primary care benefits feature no copay and no coinsurance for primary care physician visits, while specialist visits, therapies, mental health, and psychiatric services require a $20 copay and no coinsurance. Additional telehealth and other healthcare professional services have a $0 to $20 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers core preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, featuring a fitness benefit, caregiver support, and a $1,500 lifetime maximum for home safety devices, while services such as health education, nutritional therapy, and weight management programs are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams and fitting evaluations for a $20 copay and no coinsurance, alongside OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay between $399 and $1,800, though inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
HealthSpring Preferred (HMO) provides partially covered vision services, excluding other eye exam services but offering one annual routine eye exam with a $0 to $20 copay and no coinsurance. Covered eyewear has no copay, no coinsurance, and a $400 annual maximum limit for contact lenses, upgrades, and one pair of eyeglasses, lenses, and frames per year.
Dental Services See details
Dental services are partially covered by HealthSpring Preferred (HMO), offering preventive care with no copay and no coinsurance, and Medicare-covered dental services for a $20 copay and no coinsurance. Comprehensive services require copays ranging from $0 to $675 with no coinsurance up to a $20,000 annual limit, though 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. Associated Medicare Part B drugs, including chemotherapy and insulin, have coinsurance ranging from no coinsurance up to 20%, with insulin requiring a $35 copay and other drugs having no copay.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical Equipment is partially covered by HealthSpring Preferred (HMO), offering no copay and 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, all of which require prior authorization. However, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, outpatient x-rays have a $35 copay, diagnostic radiological services start at a $0 copay, therapeutic radiological services start at an $85 copay, and diagnostic procedures and tests range from a $0 to $100 copay.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred (HMO) 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 coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, carrying copays of $10, $10, $15, and $25 respectively.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and stays do not require a prior three-day hospital stay, although additional days beyond the standard 100-day Medicare 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, while acupuncture is not covered. Eligible members can receive up to $120 every three months for OTC items, as well as meals for qualifying chronic or home-confining medical conditions.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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