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HealthSpring Primary (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Primary (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Primary (HMO) in 2026, please refer to our full plan details page.
HealthSpring Primary (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Memphis/Nashville/West Tennessee. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HealthSpring Primary (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 Primary (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 Primary (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.70. 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 $615.00 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 $5000.00 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 Primary (HMO) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Specific drug tier details, copayments, and coinsurance amounts are currently unavailable for this plan. To fully understand your potential medication costs, it is recommended to verify your specific prescriptions against the plan's formulary.
Additional Benefits
The HealthSpring Primary (HMO) plan offers robust medical coverage with no copays and no coinsurance for primary care, specialist visits, preventive care, and home health services. For inpatient hospital stays, members pay a $285 daily copay for the first six days and no copay for days seven through ninety, while emergency room visits incur a $130 copay that is waived if admitted. Outpatient services feature no coinsurance, with copays ranging from no copay up to $250 depending on the service. Additional benefits include comprehensive dental coverage up to $1,650 annually and routine vision care with a $200 eyewear allowance, both featuring no copays and no coinsurance. Hearing exams are also covered with no copay, though prescription hearing aids require copays ranging from $399 to $1,800. For specialized care, medical equipment and dialysis services require a 20% coinsurance with no copays.
Inpatient Hospital See details
HealthSpring Primary (HMO) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. Covered stays require a $285 daily copay for days 1 through 6 and no copay for days 7 through 90, but additional days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
HealthSpring Primary (HMO) outpatient services feature no coinsurance, offering no copay for ambulatory surgical center and blood services, and copays ranging from $0 to $250 for outpatient hospital and observation services. For outpatient substance abuse services, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
HealthSpring Primary (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Primary (HMO) covers ambulance services with a 20% coinsurance and no copay, while transportation services are partially covered. Routine transportation to plan-approved health locations is covered for up to 24 one-way trips per year with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Primary (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with a $130 copay and no coinsurance per service.
Primary Care See details
HealthSpring Primary (HMO) covers primary care, specialist, telehealth, and opioid treatment services with no copay and no coinsurance, while physical, occupational, and speech therapies require a $10 copay and no coinsurance. Podiatry is not covered, and although some services are covered, routine and other chiropractic care, as well as individual and group sessions for mental health and psychiatric services, are not covered.
Preventive Services See details
Preventive services under HealthSpring Primary (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered with no copay and no coinsurance, excluding health education, in-home safety assessments, PERS, 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, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
HealthSpring Primary (HMO) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399.00 to $1,800.00 for up to two devices per year, excluding inner ear, outer ear, and over the ear types, while up to two OTC hearing aids are covered with a $399.00 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring Primary (HMO), featuring no copay, no coinsurance, and no deductible for covered care. The plan includes one routine eye exam per year and up to $200 annually for eyewear, such as glasses or contact lenses, while other eye exam services are not covered.
Dental Services See details
HealthSpring Primary (HMO) covers preventive and comprehensive dental services, including exams, cleanings, implants, and orthodontics, with no copay and no coinsurance up to a maximum annual benefit of $1,650. Prior authorization is required for Medicare-covered dental services, which are also available with no copay and no coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Primary (HMO) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Primary (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HealthSpring Primary (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, subject to prior authorization. This benefit is partially covered, as diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services under HealthSpring Primary (HMO) are partially covered and require prior authorization. Covered lab services have no copay and no coinsurance, while therapeutic radiological services require a 20% coinsurance and no copay; diagnostic procedures, diagnostic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the HealthSpring Primary (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under HealthSpring Primary (HMO) because cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HealthSpring Primary (HMO) with no coinsurance and no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by HealthSpring Primary (HMO), which offers over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan.
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