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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 Portland. 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 $5000.00 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. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred retail pharmacy or preferred mail-order service. Tier 2 generic prescriptions cost as little as a $4 copay for a one-month supply at preferred pharmacies, or no copay for a three-month supply ordered through preferred mail. Tier 3 preferred brand-name drugs require a flat $47 copay for a one-month supply across all pharmacy and mail-order options. Higher-tier prescriptions are subject to coinsurance, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust core medical coverage featuring no copay for primary care visits and a low $10 copay for specialists. Inpatient hospital stays require a $350 daily copay for the first five days and no copay for days 6 through 90, with no coinsurance required. Emergency care carries a $125 copay, which is waived if you are admitted, while urgently needed services require a $20 copay. For supplemental benefits, the plan provides dental care with no copay up to an $1,800 annual limit, alongside a $250 eyewear allowance with no copay. Routine hearing exams require a $10 copay, while home health services and up to 20 one-way transportation trips are fully covered with no copay. Durable medical equipment and dialysis require a 20% coinsurance, while cardiac rehabilitation and chiropractic services are not covered by this plan.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 to 5 and no copay for days 6 to 90. These services are partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute hospital days are covered.
Outpatient Services See details
Outpatient services are covered by HealthSpring Preferred (HMO) with no coinsurance across all services, including ambulatory surgical center and blood services with no copay. Outpatient hospital copays range from $0 to $350, while observation services require a $350 copay per stay and outpatient substance abuse sessions carry a $25 copay.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with an $85.00 copay and no coinsurance, although prior authorization is required.
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. Transportation services are partially covered, offering up to 20 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by HealthSpring Preferred (HMO) with a $125 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services have a $20 copay and no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $125 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, while specialists, physical therapy, and occupational therapy require a $10 copay and no coinsurance. Mental health, psychiatric, telehealth, and opioid treatment services feature copays ranging from $0 to $25 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. While caregiver support and fitness benefits are included, other additional preventive services like health education, personal emergency response systems, and nutritional benefits are not covered.
Hearing Services See details
Hearing Services covered by HealthSpring Preferred (HMO) include annual routine exams and fitting evaluations for a $10 copay and no coinsurance. OTC hearing aids require a $399 copay with no coinsurance, while prescription hearing aids are partially covered with copays ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
HealthSpring Preferred (HMO) provides partially covered vision services, which include one routine eye exam per year with a $0 to $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $250 annual maximum benefit that can be used toward contact lenses or one pair of eyeglasses per year.
Dental Services See details
HealthSpring Preferred (HMO) offers dental services with an annual maximum benefit of $1,800, featuring no copay and no coinsurance for preventive and comprehensive care like cleanings, x-rays, and periodontics. Medicare-covered dental services are also covered with a $10 copay and no coinsurance, subject to prior authorization.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
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 equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $35 copay for tests, while radiological services include a $15 copay for X-rays, starting at no copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
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 the HealthSpring Preferred (HMO) plan, as all key sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $214 daily copay for days 21 through 100, and additional days beyond the Medicare limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) provides partial coverage for other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Covered acupuncture services are limited to $300 annually, and OTC items are limited to $25 every three months.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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