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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 Northwest 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. Additionally, this plan comes with a Part B Premium reduction of $8.00. You must continue to pay paying your reduced 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 $3200.00 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 initial coverage begins. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail order services, while standard options require a $10 copay for a one-month supply. Tier 2 generic medications cost as little as a $4 copay for a one-month supply at preferred locations, compared to a $20 copay at standard pharmacies. Tier 3 preferred brand drugs carry a consistent $47 copay for a one-month supply across all pharmacy and mail order options. For higher-tier prescriptions, members pay a 50% coinsurance for Tier 4 non-preferred drugs and a 30% coinsurance for Tier 5 specialty drugs. These clear pricing structures make it easy to forecast your medication costs with the HealthSpring Preferred (HMO) plan.
Additional Benefits
HealthSpring Preferred (HMO) provides robust medical coverage with no copay or coinsurance for primary care visits and routine preventive services. For inpatient hospital stays, members pay a $150 daily copay for the first five days and no copay for days six through 90. Specialist consultations and outpatient lab services are also highly affordable, requiring low copays and no coinsurance. The plan also features excellent supplemental benefits, including comprehensive dental care with an annual maximum of $20,000 and no copay for preventive services. Vision care includes an annual routine exam and up to $300 for eyewear with no copay, while hearing aids are covered with set copayments. Members also receive a $100 quarterly allowance for over-the-counter items and home-delivered meals with no copay or coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which have no copay. Outpatient hospital services require a copay of $0 to $175 (with a $175 copay per stay for observation services), while outpatient substance abuse sessions carry a $30 copay.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $230 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Some transportation services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $65 copay and no coinsurance, with copays waived if you are 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 limit of $50,000.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, mental health, and opioid treatment services require a $30 copay and no coinsurance. Telehealth and other health professional services feature a $0 to $30 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, including annual physicals, kidney disease education, fitness benefits, caregiver support, and routine screenings. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by HealthSpring Preferred (HMO), offering routine exams and evaluations for a $25 copay and no coinsurance, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. The plan covers up to two OTC hearing aids for a $399 copay and no coinsurance, as well as up to two eligible prescription hearing aids with a copay ranging from $399 to $1,800 and no coinsurance.
Vision Services See details
HealthSpring Preferred (HMO) vision services are partially covered, excluding other eye exam services but offering one annual routine eye exam with a copay of $0 to $30 and no coinsurance. Eyewear is covered with no copay and no coinsurance up to a $300 annual maximum, which includes contact lenses, upgrades, and one pair of eyeglasses per year.
Dental Services See details
HealthSpring Preferred (HMO) offers partially covered dental services with an annual maximum benefit of $20,000, featuring no copay and no coinsurance for preventive care. Covered comprehensive services require no coinsurance and copays ranging from $0 to $675, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services are available with a $30 copay and no coinsurance.
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 a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
HealthSpring Preferred (HMO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance, subject to prior authorization. This benefit is partially covered because diabetic therapeutic shoes and inserts are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Lab services and diagnostic radiological services have no copay, while outpatient X-rays carry a $30 copay, therapeutic radiological services require a minimum $85 copay, and other diagnostic procedures range from no copay up to a $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 not covered by HealthSpring Preferred (HMO), as cardiac, intensive cardiac, pulmonary, and SET for PAD services are all not covered, meaning there is no copay or coinsurance.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100 per stay. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. Members receive a $100 allowance every three months for OTC items and home-delivered meals for qualifying medical conditions, both featuring no copay and no coinsurance.
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