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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 $4800.00 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) plan features a $200 drug deductible. For Tier 1 preferred generic drugs, members pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs are also highly affordable, starting with a $4 copay for a one-month supply at preferred pharmacies and no copay for a three-month supply through preferred mail order. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply across all pharmacy options. For higher-tier medications, members pay a 50% coinsurance for Tier 4 non-preferred drugs and a 30% coinsurance for Tier 5 specialty drugs. This plan structure helps beneficiaries minimize out-of-pocket expenses, especially when utilizing preferred pharmacies and mail-order options.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive medical coverage with no copay for primary care visits and a $20 copay for specialist appointments. For hospital care, inpatient stays require a $295 daily copay for the first six days followed by no copay, while outpatient hospital services range from no copay to a $295 copay. Emergency room visits carry a $130 copay, which is waived if you are admitted, and ground ambulance services require a $280 copay. This plan also features robust supplemental benefits, including preventive dental care with no copay up to a $2,400 annual limit and routine vision exams with a no copay to $20 copay alongside a $275 eyewear allowance. Hearing exams require a $20 copay, while hearing aids have copays ranging from $399 to $1,800. Additionally, beneficiaries pay no copay for home health services and select over-the-counter items, while durable medical equipment and dialysis services require a 20% coinsurance.
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 through 6 and no copay for days 7 through 90. Prior authorization is required, and certain services like 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 outpatient blood services with no copay. Outpatient hospital services require a copay of $0 to $295, observation services have a $295 copay per stay, and outpatient substance abuse sessions carry a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $140.00 copay and no coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $280 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services to plan-approved or health-related locations are not covered under this 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 have a $30 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance up to a $50,000 maximum benefit.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, alongside specialist, occupational, and physical therapy services for a $20 copay and no coinsurance. While podiatry is not covered, some chiropractic, psychiatric, and mental health specialty services are covered, though routine chiropractic care, other chiropractic services, and individual or group therapy sessions are not covered.
Preventive Services See details
Preventive services are partially covered by HealthSpring Preferred (HMO) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and fitness programs. Uncovered 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, enhanced disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred (HMO) with no deductible, including annual routine exams and fitting evaluations for a $20 copay and no coinsurance. Prescription hearing aids are partially covered (excluding inner, outer, and over-the-ear models) with a $399 to $1,800 copay and no coinsurance, while OTC hearing aids have a $399 copay and no coinsurance, both limited to two per year.
Vision Services See details
HealthSpring Preferred (HMO) covers one routine eye exam per year with no deductible, no coinsurance, and a $0 to $20 copay, though other eye exam services are not covered. Eyewear is also covered with no deductible, no copay, and no coinsurance up to a $275 annual maximum toward contact lenses or one pair of eyeglasses.
Dental Services See details
Dental services are covered by HealthSpring Preferred (HMO), featuring a $20 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for other preventive and comprehensive services. These additional dental services, which include cleanings, exams, x-rays, and restorative treatments, are subject to a maximum yearly benefit of $2,400.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Medicare Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
HealthSpring Preferred (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered under this plan, offering therapeutic shoes and inserts with no copay and a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HealthSpring Preferred (HMO) with prior authorization required. Lab services, diagnostic radiological services, and outpatient X-rays require no copay, diagnostic procedures and tests have a copay of up 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring Preferred (HMO) plan, as none of the sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) stays with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and 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 and meal benefits with no copay and no coinsurance, while acupuncture is not covered. Covered benefits include up to $70 every three months for OTC items and limited-duration meals for chronic or homebound conditions.
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