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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 $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 Preferred (HMO) Medicare plan features a $200 drug deductible before coverage begins for higher-tier medications. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service, while standard pharmacies charge a $10 copay for a 1-month supply. Tier 2 generic drugs cost as little as a $4 copay for a 1-month supply at preferred locations, and there is no copay for a 3-month supply filled through preferred mail order. Tier 3 preferred brand drugs carry a consistent $47 copay for a 1-month supply regardless of whether you use standard or preferred pharmacies and mail order. For higher-tier medications, you will pay a percentage of the cost, including 50% coinsurance for Tier 4 non-preferred drugs and 30% coinsurance for Tier 5 specialty drugs.
Additional Benefits
HealthSpring Preferred (HMO) offers affordable healthcare coverage with no copay for primary care visits, annual physical exams, and home health services. Specialist visits and physical therapy require a low $15 copay, while inpatient hospital stays carry a $280 daily copay for the first six days and no copay thereafter. Emergency room visits require a $130 copay, which is waived if you are admitted to the hospital. This plan also includes robust dental, vision, and hearing benefits, featuring a $3,000 annual maximum for preventive and comprehensive dental services with no copay. Vision care includes an annual routine eye exam with a copay up to $10 and a $225 yearly allowance for eyewear. Additionally, members receive no-copay outpatient lab services and a $45 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $280 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, offering ambulatory surgical center and blood services with no copay and no deductible. Outpatient hospital services require a copay of $0 to $295, while individual and group 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, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by HealthSpring Preferred (HMO), with ground ambulance services requiring a $300 copay and air ambulance services requiring a 20% coinsurance, both of which require prior authorization. Routine transportation services to plan-approved or health-related locations are not covered by the plan.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services 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 limit with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $15 copay and no coinsurance. Additional telehealth services range from a $0 to $15 copay with no coinsurance, but podiatry, chiropractic, mental health specialty, and psychiatric services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) offers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. This benefit is partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access, home safety devices, and counseling are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers hearing services, including annual routine hearing exams and fitting evaluations for a $15 copay and no coinsurance. Up to two OTC hearing aids are covered with a $399 copay and no coinsurance, and up to two prescription hearing aids are covered with a $399 to $1,800 copay and no coinsurance, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
HealthSpring Preferred (HMO) offers partially covered vision services with no deductibles or coinsurance, including one routine eye exam per year for a $0 to $10 copay, while other eye exams are not covered. Eyewear is covered with no copay or coinsurance up to a $225 annual maximum for contacts, upgrades, and 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 benefits, which include cleanings, exams, and restorative services, are subject to a maximum plan coverage limit of $3,000 every year.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require a coinsurance ranging from 0% (no coinsurance) to 20%, with covered insulin also carrying a $35.00 copay.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance, requiring prior authorization for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HealthSpring Preferred (HMO), with prior authorization required for all services. Outpatient lab services and X-rays feature no copay, diagnostic tests and procedures carry a copay ranging from $0 to $150 with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
HealthSpring Preferred (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred (HMO) covers some cardiac rehabilitation services with a $10 copay and no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not necessary for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by HealthSpring Preferred (HMO), with acupuncture being not covered. Covered benefits include over-the-counter (OTC) items up to $45 every three months and a limited-duration meal benefit for chronic or homebound conditions, both of which are available with no copay and no coinsurance.
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