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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 Spokane. 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 $4200.00 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 annual drug deductible of $200 before coverage begins. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs cost as little as a $4 copay for a one-month supply, or no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply at any participating pharmacy. For higher-tier medications, members pay a percentage of the drug cost, including 50% coinsurance for Tier 4 non-preferred drugs and 30% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive healthcare coverage with no copay for primary care physician visits, annual physicals, and preventive services. Specialist office visits require a low $10 copay, while emergency room visits carry a $125 copay that is waived upon hospital admission. For inpatient hospital stays, members pay a $305 daily copay for the first five days and no copay for days six through ninety. In addition to medical care, the plan features dental coverage with no copay up to an $1,100 annual limit and vision services providing up to $225 yearly for eyewear with no copay. Members also receive home health services with no copay, a $30 quarterly allowance for over-the-counter health items, and hearing exams with a $10 copay. Durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $305 daily copay for days 1 through 5 and no copay for days 6 through 90. 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 a $0 to $250 copay for outpatient hospital services and a $250 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay, while outpatient substance abuse individual and group sessions require a $20 copay.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with an $85.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
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, both requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 10 one-way trips per year to plan-approved health-related locations, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $125 copay and no coinsurance, and urgently needed services with a $20 copay and no coinsurance, with both copays waived if 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 $125 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) primary care benefits include primary care physician visits with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Physical, occupational, and speech therapies require a $20 copay with no coinsurance, while podiatry is not covered. Some mental health, psychiatric, and chiropractic services are covered with no coinsurance, but routine chiropractic care, other chiropractic services, and individual or group sessions are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams, kidney disease education, fitness benefits, and caregiver support, with no copay and no coinsurance. This benefit is partially covered, as several additional services, such as health education, weight management programs, and in-home safety assessments, are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers hearing services with no deductible, including annual routine exams and fittings for a $10 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays from $399.00 to $1,800.00 for up to two aids yearly, though inner ear, outer ear, and over the ear models are not covered. Up to two OTC hearing aids are also covered annually with a $399.00 copay and no coinsurance.
Vision Services See details
Vision services are partially covered under HealthSpring Preferred (HMO), which includes one annual routine eye exam 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, providing up to a $225 combined annual maximum benefit for contact lenses or one pair of eyeglasses.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $10.00 copay and no coinsurance, though prior authorization is required. Other preventive and comprehensive dental services—including exams, cleanings, implants, and orthodontics—are covered with no copay and no coinsurance up to a maximum annual benefit of $1,100.
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, carry a 0% to 20% coinsurance, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) covers durable medical equipment and prosthetics or medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO) with prior authorization required. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic procedures with a $0 to $35 copay, while radiological services require a $15 copay plus coinsurance for X-rays, diagnostic radiology starting at no copay, and therapeutic radiology with a minimum 20% coinsurance.
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, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $214 daily copay for days 21 through 100 per stay. Prior authorization is required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by HealthSpring Preferred (HMO), offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Covered acupuncture is capped at $300 annually, and OTC items are limited to a $30 allowance every three months.
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