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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) Medicare prescription drug plan features an annual drug deductible of $200. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail order service. For Tier 2 generic drugs, copays are as low as $4 at preferred pharmacies, with no copay for a three-month supply ordered through preferred mail delivery. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at both standard and preferred pharmacies. For Tier 4 non-preferred drugs, you will pay a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply. These cost-sharing rates apply to both pharmacy and mail-order options during the initial coverage phase.
Additional Benefits
HealthSpring Preferred (HMO) offers affordable access to essential medical care, featuring no copay for primary care visits, home health services, and preventive care. For specialist visits, outpatient hospital services, and emergency care, members can expect predictable copays with no coinsurance. Inpatient hospital stays require a daily copay of $325 for the first six days, after which there is no copay. The plan also provides strong coverage for supplemental benefits, including preventive and comprehensive dental care up to a $2,300 annual limit and eyewear up to $250, both with no copay. Skilled nursing facility stays feature no copay for the first 20 days, while durable medical equipment and dialysis services require no copay and a 20% coinsurance. Additionally, members benefit from a $90 quarterly over-the-counter allowance and a meal benefit for qualifying conditions with no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered, and prior authorization is required.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, featuring a $0 to $275 copay for outpatient hospital services and a $275 copay per stay for observation services. Outpatient substance abuse sessions require a $15 copay, while ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $260 copay and air ambulance services with a 20% coinsurance, both requiring prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and urgently needed services with a $30 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits and therapy services require prior authorization with copays of $15 to $20 and no coinsurance. Some chiropractic, mental health, and psychiatric services are covered with no coinsurance, but routine chiropractic care, individual or group sessions, and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) preventive services are partially covered with no copay and no coinsurance for covered benefits such as annual physical exams, caregiver support, and fitness programs. However, the plan does not cover health education, in-home safety assessments, PERS, MNT, 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, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling services.
Hearing Services See details
Hearing services covered by HealthSpring Preferred (HMO) include annual routine exams and fittings for a $15 copay and no coinsurance, alongside OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay of $399 to $1,800 for up to two aids yearly, excluding inner ear, outer ear, and over the ear models.
Vision Services See details
HealthSpring Preferred (HMO) covers one annual routine eye exam with a $0 to $15 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $250 annual maximum, which can be used toward contact lenses or one pair of eyeglasses per year.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $15 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a $2,300 annual maximum. Covered services include oral exams, cleanings, x-rays, endodontics, periodontics, implants, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered under HealthSpring Preferred (HMO) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin drugs carry a $35 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 to receive this covered benefit.
Medical Equipment See details
HealthSpring Preferred (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay, a 20% coinsurance, and prior authorization. Diabetic equipment is partially covered, providing diabetic therapeutic shoes and inserts with no copay and a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization required. Lab services have no copay or coinsurance, diagnostic tests have a $0 to $150 copay and no coinsurance, and radiological services range from no-copay X-rays with coinsurance to therapeutic services requiring a copay and 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 HealthSpring Preferred (HMO), as all sub-services—including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation—are excluded from coverage.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) care 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 with no copay and no coinsurance, providing a meal benefit for qualifying health conditions and a $90 quarterly allowance for Over-the-Counter (OTC) items, while acupuncture is not covered.
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