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HealthSpring Primary (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Primary (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Primary (HMO) in 2026, please refer to our full plan details page.
HealthSpring Primary (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Chattanooga/Knoxville. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HealthSpring Primary (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 Primary (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 Primary (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.90. 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 $615.00 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 $4900.00 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 Primary (HMO) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your prescription medications before your plan coverage begins to pay. Specific drug coverage tier details, such as copays and coinsurance rates for different drug tiers, are currently unavailable for this plan. To understand your potential out-of-pocket costs for specific prescriptions, it is recommended to contact the provider directly for detailed formulary information.
Additional Benefits
The HealthSpring Primary (HMO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copays for primary care visits, specialist consultations, and home health services. For inpatient hospital stays, members pay a $250 daily copay for days one through six and no copay for days seven through 90. Emergency room visits carry a $130 copay and urgent care requires a $20 copay, with no coinsurance for either service. Beyond standard medical care, this plan provides valuable extra benefits including routine vision and comprehensive dental care with no copays, no coinsurance, and a generous $2,500 annual dental limit. Routine hearing exams and fitting evaluations also feature no copay, while prescription hearing aids require a copayment between $399 and $1,800. Additionally, members benefit from no copays on up to 20 one-way transportation trips annually and a $130 quarterly over-the-counter allowance.
Inpatient Hospital See details
HealthSpring Primary (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $250 daily copay for days 1 through 6 and 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 Primary (HMO) covers outpatient hospital services with a $0 to $250 copay and observation services with a $250 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services feature no copay and no coinsurance, while outpatient substance abuse services cover some services with no copay and no coinsurance but exclude individual and group sessions.
Partial Hospitalization See details
HealthSpring Primary (HMO) covers partial hospitalization services with a copay of $140.00 and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HealthSpring Primary (HMO) covers ambulance and transportation services, though transportation is only partially covered as trips to any health-related location are not covered. Ground ambulance services require a $255 copay with no coinsurance, air ambulance services require a 20% coinsurance with no copay, and plan-approved transportation is covered for up to 20 one-way trips per year with no copay or coinsurance.
Emergency Services See details
HealthSpring Primary (HMO) covers emergency services with a $130 copay and urgently needed services with a $20 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 with a $130 copay and no coinsurance, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring Primary (HMO) offers primary care, specialist visits, telehealth, and opioid treatment with no copay and no coinsurance, while physical, occupational, and speech therapies require a $10 copay and no coinsurance. Podiatry is not covered, and while chiropractic, mental health, and psychiatric benefits are listed, only some services are covered as routine chiropractic, other chiropractic, and individual or group sessions for mental health and psychiatry are not covered.
Preventive Services See details
Preventive services are partially covered by HealthSpring Primary (HMO) with no copay and no coinsurance for annual physicals, caregiver support, and fitness benefits. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by HealthSpring Primary (HMO), offering annual routine exams and fitting evaluations with no copay and no coinsurance. Up to two OTC hearing aids are covered with a $399 copay and no coinsurance, while up to two prescription hearing aids are covered with no coinsurance and a copay between $399 and $1,800, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Primary (HMO) provides partially covered vision services with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. This benefit includes one routine eye exam per year and a $250 annual combined maximum allowance for eyewear, including contact lenses, eyeglass lenses, and frames.
Dental Services See details
HealthSpring Primary (HMO) covers comprehensive and preventive dental services, including cleanings, implants, and orthodontics, with no copay and no coinsurance. These covered services are subject to a maximum annual plan benefit of $2,500.
Home Infusion bundled Services See details
HealthSpring Primary (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, feature no coinsurance to 20% coinsurance, with insulin specifically requiring a $35 copay.
Dialysis Services See details
HealthSpring Primary (HMO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HealthSpring Primary (HMO) with no copay and 20% coinsurance, subject to prior authorization. This benefit is partially covered because diabetic supplies are not covered, though durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring Primary (HMO), with prior authorization required for all covered services. Covered lab services have no copay and no coinsurance, and therapeutic radiological services require a 20% coinsurance and no copay, while diagnostic procedures and tests, diagnostic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by HealthSpring Primary (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the HealthSpring Primary (HMO) plan, but in practice only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Primary (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Primary (HMO) partially covers Other Services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $130 every three months for covered health items, and the limited-duration meal benefit is available for members with qualifying chronic or medical conditions.
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