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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 Philadelphia. 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 $6500.00 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 annual drug deductible before coverage begins. For Tier 1 preferred generic drugs, members enjoy no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic prescriptions are also highly affordable, costing as little as a $4 copay for a one-month supply, or no copay for a three-month supply filled via preferred mail order. 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 medications, members pay a 50% coinsurance for Tier 4 non-preferred drugs and a 30% coinsurance for Tier 5 specialty drugs. Utilizing preferred network pharmacies and mail-order services offers the most cost-effective way to manage your prescription expenses under this plan.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust coverage with no copays for primary care visits, preventive services, and home health care. Specialist visits, physical therapy, and routine hearing or dental exams are highly affordable, requiring a low $15 copay and no coinsurance. For more intensive care, inpatient hospital stays require a daily copay for the first several days before transitioning to no copay, while emergency room visits carry a $130 copay that is waived if you are admitted. Members also benefit from valuable extras, including up to $1,700 in dental coverage and a $200 annual eyewear allowance with no copay or coinsurance. Additionally, the plan covers up to 20 free one-way transportation trips to approved locations per year and provides a $60 quarterly over-the-counter item allowance with no copay. Other services like diagnostic lab tests and home infusions require no copay, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $285 copay for days 1 to 7 and no copay for days 8 to 90, while psychiatric stays require a $335 copay for days 1 to 6 and no copay for days 7 to 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, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay between $0 and $325, observation services cost a $325 copay per stay, and outpatient substance abuse sessions have a $15 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the HealthSpring Preferred (HMO) plan with a $140.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance services with a $220 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are partially covered with no copay and no 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
HealthSpring Preferred (HMO) covers emergency services 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 with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, mental health, and psychiatric services require a $15 copay and no coinsurance. Telehealth and other healthcare professional services range from a $0 to $15 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services under HealthSpring Preferred (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. This benefit is partially covered because sub-services like health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred (HMO), featuring a $15 copay and no coinsurance for annual routine hearing exams and fittings. Hearing aids are partially covered with no coinsurance, requiring a $399 copay for OTC models and copays between $399 and $1,800 for up to two prescription aids per year, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
HealthSpring Preferred (HMO) vision services cover one routine eye exam per year with a $0 to $15 copay and no coinsurance, though other types of eye exams are not covered. Eyewear is covered with no copay or coinsurance up to a $200 annual maximum, which can be used toward contact lenses, upgrades, or one pair of eyeglasses.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $15 copay and no coinsurance, while preventive and comprehensive dental services are covered with no copay and no coinsurance up to a $1,700 maximum annual benefit.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, feature coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Preferred (HMO) plan with no copay and a 20% coinsurance, though 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. 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 require a $40 copay, and other diagnostic and radiological services feature copays ranging from $0 to $50, or a minimum of $85 for therapeutic services.
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
HealthSpring Preferred (HMO) does not cover Cardiac Rehabilitation Services, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
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 additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, providing over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $60 every three months for OTC items, and the meal benefit is available for those with chronic or qualifying medical conditions.
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