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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 Tennessee. 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 $5100.00 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 $200. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic medications cost a $4 copay for a one-month supply at preferred pharmacies, while standard pharmacies charge a $20 copay. Tier 3 preferred brand drugs carry a consistent $47 copay for a one-month supply at both preferred and standard pharmacies. For higher-tier medications, members pay a 50% coinsurance for Tier 4 non-preferred drugs and a 30% coinsurance for Tier 5 specialty drugs.
Additional Benefits
HealthSpring Preferred (HMO) offers comprehensive medical coverage with no copay for primary care doctor visits and a $15 copay for specialist appointments. Inpatient hospital stays require a $295 daily copay for the first six days and no copay for days 7 through 90, while emergency room visits carry a $130 copay. Preventive care, home health services, and routine dental cleanings are fully covered with no copay or coinsurance. The plan also features robust dental, vision, and hearing benefits, including a $2,550 annual maximum for comprehensive dental services with no copay and up to $350 yearly for eyewear with no copay. Routine hearing exams require a $15 copay, and prescription hearing aids are available with copays ranging from $399 to $1,800. Additionally, members pay a 20% coinsurance for medical equipment and dialysis services, alongside receiving an over-the-counter item allowance of $110 every three months.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 to 6 and no copay for days 7 to 90. Prior authorization is required, and certain services such as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $295, observation services carry a $295 copay per stay, and outpatient substance abuse sessions have a $30 copay, with prior authorization required for most 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 this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance services with a $255 copay and coinsurance for ground transport, and a 20% coinsurance and copay for air transport. Transportation services are partially covered with no copay or coinsurance for up to 10 one-way trips per year to plan-approved locations, though trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by HealthSpring Preferred (HMO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum 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 visits, occupational therapy, and physical therapy require a $15 copay and no coinsurance. Chiropractic, psychiatric, and mental health specialty services are partially covered, with routine chiropractic care and individual or group therapy sessions excluded from coverage. Podiatry services are not covered.
Preventive Services See details
Preventive Services under HealthSpring Preferred (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and glaucoma screenings. While fitness benefits and caregiver support are covered, this benefit is only partially covered as services like health education, weight management, and nutritional therapy are not covered.
Hearing Services See details
Hearing services covered by HealthSpring Preferred (HMO) include annual routine exams and fittings for a $15 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $399 and $1,800 for up to two devices yearly, though inner ear, outer ear, and over-the-ear types are not covered. Up to two OTC hearing aids are also covered annually with a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), offering one routine eye exam per year with a $0 to $10 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $350 annual maximum benefit toward contact lenses, upgrades, or one pair of eyeglasses per year.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare dental services with a $15 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance. These additional dental services, including cleanings, exams, and implants, are covered up to a maximum annual benefit of $2,550.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs require no 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. Prior authorization is required for these services.
Medical Equipment See details
HealthSpring Preferred (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic therapeutic shoes, with no copay and a 20% coinsurance, subject to prior authorization. This benefit is partially covered, as diabetic supplies are not covered, and diabetic services are limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO), with prior authorization required for these benefits. Diagnostic services feature no coinsurance, offering no copay for lab services and a copay of $0 to $150 for procedures, while radiological services include no copay for outpatient X-rays and a minimum 20% coinsurance for therapeutic radiation.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HealthSpring Preferred (HMO) with no coinsurance, although prior authorization is required. While some services are covered, specific sub-services including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered and require a $10 copay.
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 Over-the-Counter (OTC) items up to $110 every three months and a medical meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan.
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