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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 2026 to people living in South New Jersey. 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 $7500.00 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 and offers excellent savings on generic medications. For Tier 1 preferred generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generics are also highly affordable, starting at a $4 copay for a one-month supply at preferred pharmacies, with no copay for a three-month supply ordered through preferred mail delivery. For brand-name and specialty medications, the plan transitions to flat copays and coinsurance. Tier 3 preferred brands cost a flat $47 copay for a one-month supply across all pharmacy and mail-order options. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply.
Additional Benefits
HealthSpring Preferred (HMO) offers dependable medical coverage with no copay or coinsurance for primary care visits, while specialist visits require a $40 copay. Inpatient hospital stays require a daily copay of $320 for the first six days of acute stays, followed by no copay for days 7 through 90. Emergency care is covered with a $115 copay, and urgent care is available for a $40 copay, with both fees waived if you are admitted to the hospital. The plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay up to a $950 annual maximum. Routine eye exams range from no copay to a $25 copay, and eyewear is covered with no copay up to a $100 annual limit. Additionally, routine hearing exams require a $25 copay, and members receive coverage with no copay for home health services and diagnostic lab tests.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a daily copay of $320 for days 1 through 6 of acute stays and $345 for days 1 through 6 of psychiatric stays, followed by no copay for days 7 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, featuring a copay ranging from $0 to $350 for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copay, while outpatient substance abuse individual and group sessions require a $40 copay.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance services requiring prior authorization, with a $260 copay for ground transport and 20% coinsurance for air transport. While transportation benefits are technically offered, some services are covered but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by HealthSpring Preferred (HMO) with a $115 copay and no coinsurance, while urgently needed services require a $40 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum benefit with a $115 copay and no coinsurance per service.
Primary Care See details
HealthSpring Preferred (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $40 copay and no coinsurance. Covered physical, occupational, and speech therapy services have a $35 copay and no coinsurance, whereas podiatry and chiropractic services are not covered. Mental health, psychiatric, and telehealth services are also available with copays ranging up to $40 and no coinsurance.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. These additional preventive services are only partially covered, as caregiver support is included, but fitness benefits, health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams and fitting evaluations once annually with a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $399 to $1,800, though inner ear, outer ear, and over the ear models are not covered. Up to two over-the-counter (OTC) hearing aids are also covered each year with a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO) with no deductibles, as other eye exam services are not covered. Routine eye exams are covered with a $0 to $25 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $100 annual limit for contacts or one pair of eyeglasses.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $40 copay and no coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance, up to a maximum plan benefit of $950 every year.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs incur no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for these services.
Medical Equipment See details
Medical Equipment is partially covered by HealthSpring Preferred (HMO), as diabetic supplies are not covered under the plan. Covered items such as durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes require prior authorization and feature no copays and a 20% coinsurance.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. There is no copay for lab services, while diagnostic procedures range from a $0 to $100 copay, outpatient X-rays require a $50 copay, and therapeutic radiology copays start at $85.
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 copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, providing over-the-counter (OTC) items and limited-duration meal benefits with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit offers up to $20 every three months for health-related items, and meals are covered for qualifying chronic illnesses or medical conditions.
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