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HealthSpring Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Premier (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Premier (HMO-POS) in 2026, please refer to our full plan details page.
HealthSpring Premier (HMO-POS) is a HMO-POS plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Tennessee. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HealthSpring Premier (HMO-POS) 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 Premier (HMO-POS).
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 Premier (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $45.00. 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 $250.00 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 $6150.00 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 Premier (HMO-POS) Medicare plan features an annual prescription drug deductible of $250. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order, compared to a $10 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs cost as little as an $8 copay for a one-month supply at preferred locations, with no copay required for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a consistent $47 copay for a one-month supply at both preferred and standard pharmacies. Higher-tier medications are subject to coinsurance instead of flat copays, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply.
Additional Benefits
HealthSpring Premier (HMO-POS) offers comprehensive medical coverage featuring no copays for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $295 copay for the first six days and no copay for days seven through ninety, with no coinsurance required. Outpatient services, specialist visits, and emergency care are also covered, with emergency services requiring a $130 copay that is waived if the member is admitted. The plan also provides valuable supplemental benefits, including preventive and comprehensive dental care with no copay up to a $2,000 annual limit. Vision and hearing benefits are covered, featuring no copay on eyewear up to $300 annually and hearing aid coverage with copays starting at $399. Additionally, members can take advantage of over-the-counter item allowances and home-delivered meals with no copay or coinsurance.
Inpatient Hospital See details
HealthSpring Premier (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Premier (HMO-POS) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $295, and ambulatory surgical center services with no copay and no coinsurance. Outpatient substance abuse services require a $25 copay per session with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
HealthSpring Premier (HMO-POS) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HealthSpring Premier (HMO-POS) covers ambulance and transportation services with prior authorization, requiring a $270 copay and coinsurance for ground ambulance, and a copay and 20% coinsurance for air ambulance. Transportation services are partially covered with no copay or coinsurance for up to 10 yearly one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
Emergency services are covered by HealthSpring Premier (HMO-POS) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum limit with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Premier (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $25 copay and no coinsurance. Some chiropractic, mental health, and psychiatric services are covered with no coinsurance, but routine chiropractic care, other chiropractic services, and individual or group therapy sessions are not covered. Podiatry is not covered, but telehealth and opioid treatment are covered with no coinsurance and copays up to $25.
Preventive Services See details
Preventive services are covered by HealthSpring Premier (HMO-POS) with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. Additional preventive services are partially covered, excluding health education, weight management, nutritional benefits, alternative therapies, personal emergency response systems, in-home support, and telemonitoring.
Hearing Services See details
HealthSpring Premier (HMO-POS) covers hearing services, including annual routine exams and fittings for a $25 copay and no coinsurance. OTC hearing aids are covered with a $399 copay and no coinsurance, while prescription hearing aids are partially covered with a $399 to $1,800 copay and no coinsurance. Under the prescription benefit, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
HealthSpring Premier (HMO-POS) offers partially covered vision services, featuring 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 no deductible, providing a combined maximum benefit of $300 annually for contacts, eyeglass lenses, frames, and upgrades.
Dental Services See details
Dental services are covered by HealthSpring Premier (HMO-POS), with Medicare-covered dental services requiring a $25 copay and no coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a $2,000 maximum annual benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HealthSpring Premier (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HealthSpring Premier (HMO-POS) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Premier (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay, a 20% coinsurance, and prior authorization requirements. Diabetic equipment is partially covered, with therapeutic shoes and inserts covered at a 20% coinsurance and no copay, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Premier (HMO-POS) with no coinsurance, although prior authorization is required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests range from a $0 to $150 copay, diagnostic radiological services have a minimum $0 copay, and therapeutic radiological services carry a minimum $30 copay.
Home Health Services See details
HealthSpring Premier (HMO-POS) offers coverage for Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Premier (HMO-POS) covers cardiac rehabilitation services with no coinsurance, although prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by HealthSpring Premier (HMO-POS), as additional days beyond the Medicare-covered limit are not covered. Covered stays require prior authorization with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
Other Services are partially covered under the HealthSpring Premier (HMO-POS) plan, which excludes acupuncture but includes meal benefits and over-the-counter (OTC) items with no copay and no coinsurance. Eligible members receive up to $65 every three months for OTC items, as well as home-delivered meals for qualifying chronic illnesses or medical conditions.
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