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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 South Mississippi. This plan received an overall rating of 4 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 $5200.00 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 plan features a $200 drug deductible and offers significant savings on generic medications. Under this plan, Tier 1 preferred generic drugs have no copay when filled at a preferred pharmacy or through preferred mail order, whereas standard pharmacies charge a $10 monthly copay. Tier 2 generic drugs cost just $5 per month at preferred locations, and you can even receive a three-month supply with no copay through preferred mail order. For brand-name and specialty prescriptions, Tier 3 preferred brand drugs require a flat $47 monthly copay across all pharmacy and mail order options. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply.
Additional Benefits
HealthSpring Preferred (HMO) offers robust coverage for everyday healthcare needs, featuring no copays and no coinsurance for primary care, specialist visits, telehealth, and preventive services. For emergency care, there is a 130 dollar copay with no coinsurance, while inpatient hospital stays require a 250 dollar daily copay for the first six to seven days and no copay thereafter. Outpatient services, laboratory tests, and diagnostic x-rays are also highly affordable, requiring no copays and no coinsurance. This plan also provides excellent supplemental benefits, including comprehensive dental care up to 2,000 dollars annually and routine vision and hearing exams, all with no copays and no coinsurance. Prescription hearing aids require copays starting at 399 dollars, while durable medical equipment and dialysis services feature a 20 percent coinsurance with no copay. Additionally, members can access home health services, over-the-counter items, and select meals with no copays and no coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient hospital stays with no coinsurance, requiring a $250 daily copay for days 1 to 6 of acute stays and days 1 to 7 of psychiatric stays, with no copay for subsequent days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and copays ranging from $0 to $290 for outpatient hospital and observation services. Outpatient substance abuse services require a $35 copay per individual or group session with no coinsurance, and prior authorization is required for most outpatient benefits.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $140.00 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are not covered under this plan.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance and waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent care, and emergency transportation are also covered up to a $50,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care, specialist, and telehealth services with no copay and no coinsurance. Physical, occupational, and speech therapies, alongside opioid treatment, require a $35 copay and no coinsurance, while chiropractic, psychiatric, mental health specialty, and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, such as annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are partially covered, including fitness benefits and caregiver support, while services like health education, weight management programs, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams and fittings with no copay and no coinsurance. Hearing services are partially covered, as OTC hearing aids require a $399.00 copay and no coinsurance, while prescription hearing aids require a copay between $399.00 and $1,800.00 and no coinsurance, with inner ear, outer ear, and over the ear types not covered.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO) with no copay, no coinsurance, and no deductible for covered services. This benefit includes one routine eye exam per year and up to a $400 annual maximum for eyewear, including contact lenses and one pair of eyeglasses, while other eye exam services are not covered.
Dental Services See details
HealthSpring Preferred (HMO) covers comprehensive dental services with no copay and no coinsurance, up to a maximum benefit of $2,000 every year. Covered services include preventive care, endodontics, implants, and orthodontics, all available with no copays or coinsurance.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B drugs associated with these services, including chemotherapy, radiation, and insulin, carry no coinsurance to 20% coinsurance, 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 a 20% coinsurance, subject to prior authorization. Diabetic therapeutic shoes and inserts are also covered under these same terms, but diabetic supplies are not covered by the plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO) with no coinsurance, though prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests carry a copay of $0 to $75, and therapeutic radiological services have a minimum copay of $80.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred (HMO) covers some Cardiac Rehabilitation Services with no coinsurance and prior authorization required, but specific sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) partially covers skilled nursing facility (SNF) services, excluding days beyond the Medicare-covered limit, with no coinsurance and required prior authorization. Covered stays feature a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, without requiring a prior three-day hospital stay.
Other Services See details
HealthSpring Preferred (HMO) provides partially covered other services, excluding acupuncture, but featuring over-the-counter (OTC) items and meal benefits with no copay and no coinsurance. Covered OTC benefits include up to $60 every three months, and meal benefits are available for qualifying medical conditions or chronic illnesses.
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