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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 Texas. 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 $3500.00 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. Tier 1 preferred generic drugs have no copay when filled through a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, starting at a $2 copay for a one-month supply at preferred locations. For brand-name and specialty medications, Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply across all pharmacy types. Tier 4 non-preferred drugs carry a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred (HMO) plan provides comprehensive coverage for essential medical services, featuring no copay and no coinsurance for primary care physician visits, preventive care, and home health services. Specialists and urgent care visits are highly affordable, requiring only a $20 to $25 copay with no coinsurance. For more intensive care, inpatient hospital stays require a $230 copay per stay, while emergency room visits have a $150 copay. In addition to medical care, the plan offers generous supplemental benefits, including preventive and comprehensive dental services with no copay or coinsurance up to a $2,550 annual limit. Vision benefits include routine eye exams with a copay of up to $20 and a $300 annual allowance for eyewear with no copay. Members also benefit from a $135 allowance every three months for over-the-counter items and a meal benefit, both provided with no copay and no coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $230 copay per stay for unlimited acute care and a $350 daily copay for days 1 to 4 of psychiatric care, followed by no copay for days 5 to 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, featuring a copay of $0 to $150 for outpatient hospital services, a $175 copay per stay for observation services, and a $25 copay for substance abuse sessions. Ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by HealthSpring Preferred (HMO) with a $175 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring Preferred (HMO), with ground ambulance requiring a $250 copay and no coinsurance, and air ambulance requiring a 20% coinsurance and no copay, both subject to prior authorization. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved locations, while transportation to any other health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with 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 benefit with a $150 copay and no coinsurance per service.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapies, and opioid treatment require a $20 to $25 copay and no coinsurance. Telehealth and other health professional services range from no copay to a $20 copay with no coinsurance, but podiatry, routine chiropractic care, and individual or group mental health and psychiatric sessions are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness and caregiver support, but sub-services such as health education, weight management, and nutritional therapy are not covered.
Hearing Services See details
Hearing services are partially covered by HealthSpring Preferred (HMO), offering annual routine exams and fitting evaluations for a $20 copay and no coinsurance. Up to two prescription hearing aids per year are covered with a copay ranging from $399 to $1,800 and no coinsurance, while over-the-counter hearing aids require a $399 copay and no coinsurance; however, inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Preferred (HMO) provides partially covered vision services with no deductibles, including one routine eye exam per year with a copay ranging from no copay to $20 and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $300 annual maximum, which covers contact lenses, upgrades, and one pair of eyeglasses per year.
Dental Services See details
Dental Services under HealthSpring Preferred (HMO) are covered with no copay and no coinsurance for preventive and comprehensive care, up to a maximum annual benefit of $2,550. Medicare-covered dental services require prior authorization and have a $20 copay with no coinsurance.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this covered care.
Medical Equipment See details
HealthSpring Preferred (HMO) covers medical equipment 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 because diabetic supplies are not covered by the plan.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Lab services and diagnostic radiology have no copay, outpatient X-rays require a $5 copay, therapeutic radiology has a minimum $85 copay, and diagnostic procedures range from no copay up to $150.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Preferred (HMO) with no coinsurance, though prior authorization and referrals are required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered in practice and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $20 copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required, and 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 for a meal benefit and over-the-counter (OTC) items, which include a maximum allowance of $135 every three months. Acupuncture and other additional services are not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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