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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 North Georgia. 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 $300.00 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 $5700.00 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 an annual drug deductible of $300. 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 an $8 copay for a one-month supply at preferred locations, and there is no copay for a three-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply, regardless of whether you use preferred or standard pharmacies and mail order. For higher-tier medications, you will pay a coinsurance rather than a copay, which includes 50% coinsurance for Tier 4 non-preferred drugs and 29% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers affordable healthcare coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $295 for days one through six of an acute stay and no copay for days seven through 90. Emergency room visits require a $130 copay, which is waived if you are admitted, while specialist visits and urgent care services carry a $25 copay. This plan also includes valuable supplemental benefits, featuring comprehensive dental coverage up to a $2,000 annual limit and eyewear coverage up to $350 annually with no copay. Routine hearing exams require a $20 copay, and members receive a $70 quarterly allowance for over-the-counter items. Skilled nursing facility stays are also covered with no copay for the first 20 days, while medical equipment is available with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $295 copay per day for days 1 through 6 of an acute stay and a $325 copay per day for days 1 through 6 of a psychiatric stay, with 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 hospital services with a $0 to $295 copay and observation services with a $295 copay per stay, both with no coinsurance. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are also covered with no coinsurance, featuring a $25 copay for substance abuse sessions and no copay for ambulatory surgical and blood services.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $275 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. For transportation, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and urgently needed services with a $25 copay, with no coinsurance for either service and 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 limit 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, occupational, and physical therapy services require a $25 copay and no coinsurance. Podiatry is not covered, and although some chiropractic, mental health, and psychiatric services are covered with no coinsurance, routine chiropractic care, other chiropractic services, and individual or group mental health and psychiatric sessions are not covered. Telehealth, opioid treatment, and other professional health services are covered with no coinsurance and copays ranging from $0 to $25.
Preventive Services See details
Preventive services are partially covered by HealthSpring Preferred (HMO) with no copay and no coinsurance for covered benefits such as annual physical exams, fitness programs, and caregiver support. However, many supplemental benefits are not covered under this plan, including health education, weight management, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams and evaluations with a $20 copay, no deductible, and no coinsurance, as well as up to two OTC hearing aids yearly for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $399 to $1,800 and no coinsurance, but inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), which offers 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 and no coinsurance up to a $350 annual maximum, which includes contact lenses, upgrades, and one pair of eyeglasses, lenses, and frames per year.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $25 copay and no coinsurance, which require prior authorization. Other preventive and comprehensive dental services are fully covered with no copay and no coinsurance up to an annual maximum benefit of $2,000.
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 incur no coinsurance to 20% coinsurance, while Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
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) covers medical equipment, including durable medical equipment and prosthetics, with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered, as diabetic therapeutic shoes and inserts are covered with no copay and 20% coinsurance, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by HealthSpring Preferred (HMO) with no coinsurance, although prior authorization is required. There is no copay for lab and outpatient X-ray services, while diagnostic procedures range from a $0 to $225 copay, and therapeutic radiological services require a minimum $55 copay.
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 coinsurance and require prior authorization, though some services are not covered. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation 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 requirement, though prior authorization is required. There is no copay for days 1 through 20 of your stay, 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, offering over-the-counter (OTC) items with a $70 quarterly limit and a qualifying meal benefit with no copay and no coinsurance for both, though acupuncture is not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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