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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 Knoxville. 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 $4650.00 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) prescription drug plan features an annual drug deductible of $300. You can enjoy no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail-order service. For Tier 2 generic medications, copays start at $8 at preferred locations, including no copay for a 3-month supply filled via preferred mail order. For Tier 3 preferred brand drugs, you will pay a flat $47 copay for a 1-month supply regardless of the pharmacy type you choose. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 29% coinsurance for a 1-month supply.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay for primary care visits and preventive services. Specialist visits require a $25 copay, while emergency room care has a $130 copay that is waived if you are admitted. For hospital stays, there is no coinsurance, though inpatient admissions require a $340 daily copay for the first six days, and skilled nursing facility stays have no copay for the first 20 days. This plan also provides extensive ancillary benefits, including up to $2,900 annually in dental care with no copay and a $250 annual allowance for eyewear. Routine hearing exams carry a $20 copay, and members can access up to 50 free one-way transportation trips per year to approved health locations. Additionally, durable medical equipment is covered with a 20% coinsurance, and members receive a $70 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $340 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 Preferred (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital care copays range from $0 to $350, outpatient observation services cost a $350 copay per stay, and outpatient substance abuse sessions require a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $140 copay and no coinsurance, although prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services under HealthSpring Preferred (HMO) are covered, featuring a $270 copay for ground ambulance transport and a 20% coinsurance for air ambulance services, with prior authorization required. Transportation services are partially covered, offering up to 50 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $30 copay and no coinsurance, with copays waived if you are 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 per service.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, while specialist, physical, and occupational therapy visits require a $25 copay and no coinsurance. Some chiropractic services are covered with a $15 copay and no coinsurance, and some mental health and psychiatric services have no copay and no coinsurance, but routine chiropractic, individual and group sessions, and podiatry are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Although fitness benefits and caregiver support are included, this benefit is partially covered as sub-services like health education, weight management, and nutrition therapy are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams and evaluations with a $20 copay and no coinsurance, and OTC hearing aids with a $399 copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $1,800 copay and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), which excludes other eye exam services but offers one routine eye exam per year with a $0 to $10 copay and no coinsurance. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $250 annual maximum for contact lenses and one pair of eyeglasses.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $25 copay and no coinsurance, subject to prior authorization. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum plan benefit of $2,900 every year.
Home Infusion bundled Services See details
Home infusion bundled services are covered under HealthSpring Preferred (HMO) with no copay, though prior authorization is required and step therapy may apply. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, although prior authorization is required. Diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab services, outpatient x-rays, and diagnostic radiological services, while diagnostic procedures and tests carry a copay of $0 to $200, and therapeutic radiological services require a minimum copay of $60.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring Preferred (HMO) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all excluded from coverage.
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, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, offering a meal benefit and up to $70 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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