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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 Western Pennsylvania. 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 $21.00. 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 Plus (HMO) plan features a $200 annual drug deductible and offers highly affordable generic medication options. You will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail order service. For Tier 2 generic drugs, copays are as low as $4 for a one-month supply at preferred locations, with no copay required for a three-month supply filled through preferred mail order. Tier 3 preferred brand-name drugs carry a consistent $47 copay for a one-month supply at both preferred and standard pharmacies. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance.
Additional Benefits
The HealthSpring Preferred Plus (HMO) plan offers comprehensive medical coverage with a strong focus on affordable copayments and no coinsurance for many core services. Members benefit from no copay for primary care visits, while specialist visits and diagnostic lab services require a low $20 copay or no copay. Emergency room visits carry a $150 copay, which is waived if admitted, and inpatient hospital stays require a $250 copay per stay for acute care with no coinsurance. This plan also includes valuable supplemental benefits, such as routine dental and home health services with no copay or coinsurance. Vision care features an annual routine eye exam with a copay up to $20 and an eyewear allowance of up to $450 with no copay. Additionally, members can access over-the-counter items with a $140 quarterly allowance and no copay, alongside up to 20 one-way routine transportation trips per year at no cost.
Inpatient Hospital See details
Inpatient hospital services are covered by HealthSpring Preferred Plus (HMO) with no coinsurance, requiring a $250 copay per stay for acute care and a $225 daily copay for days 1 through 7 (and no copay for days 8 through 90) for psychiatric care. Both services require prior authorization, while additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred Plus (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a $0 to $175 copay, observation services require a $175 copay per stay, and outpatient substance abuse sessions carry a $20 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred Plus (HMO) with a $175.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring Preferred Plus (HMO), with ground ambulance services requiring a $230 copay (no coinsurance) and air ambulance services requiring a 20% coinsurance (no copay). Transportation benefits are partially covered, offering up to 20 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
HealthSpring Preferred Plus (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 limit with a $150 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, therapy, psychiatric, and mental health services require a $20 copay and no coinsurance. Additional telehealth and other healthcare professional services feature copays ranging from $0 to $20 with no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
HealthSpring Preferred Plus (HMO) offers preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, kidney disease education, and fitness programs. However, these services are only partially covered, as supplemental benefits such as health education, weight management, and personal emergency response systems are not covered.
Hearing Services See details
HealthSpring Preferred Plus (HMO) hearing services are covered, featuring a $20 copay and no coinsurance for exams, and a $399 copay and no coinsurance for OTC hearing aids. Prescription hearing aids are partially covered with copays ranging from $399 to $1,800 and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Preferred Plus (HMO) covers vision services, offering one routine eye exam per year with a $0 to $20 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $450 annual maximum, which includes contact lenses and one pair of eyeglasses per year.
Dental Services See details
HealthSpring Preferred Plus (HMO) dental services are partially covered, offering preventive care with no copay and no coinsurance, and Medicare-covered dental for a $20 copay and no coinsurance. Comprehensive services are covered with 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 Plus (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while 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 Plus (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
HealthSpring Preferred Plus (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, though 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. Under this plan, lab services have no copay, outpatient X-rays require a $20 copay, therapeutic radiological services have a minimum $85 copay, and diagnostic procedures carry a copay of $0 to $50.
Home Health Services See details
Home Health Services are covered under the HealthSpring Preferred Plus (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice under HealthSpring Preferred Plus (HMO), as specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered despite having a listed $10 copay and no coinsurance.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $15 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100 per stay. Prior authorization is required, a 3-day prior hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred Plus (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. The OTC benefit provides up to $140 every three months for health-related items, and the meal benefit is available for members with qualifying chronic or medical conditions.
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