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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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $3400.00 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. For Tier 1 preferred generic drugs, you will pay no copay when using 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 pharmacies and dropping to no copay for a three-month supply via preferred mail order. Tier 3 preferred brand drugs carry a consistent $47 copay for a one-month supply across all pharmacy and mail-order options. Higher-tier prescriptions require coinsurance rather than flat copays, with Tier 4 non-preferred drugs costing 50% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance for a one-month supply. These structured costs help you easily estimate your out-of-pocket prescription expenses under the HealthSpring Preferred (HMO) plan.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers affordable coverage for core medical needs, featuring no copay and no coinsurance for primary care visits and preventive services. Specialist visits and routine hearing exams require a low $15 copay, while emergency room visits carry a $150 copay with no coinsurance. Inpatient hospital stays require a $350 copay with no coinsurance, whereas outpatient surgery and home health services are available with no copay. For supplemental care, the plan features no copay and no coinsurance for routine dental services up to a $3,000 annual maximum and eyewear up to a $325 yearly limit. Members also receive an over-the-counter benefit of $135 every three months and home-delivered meals at no cost. Note that specialized services like dialysis and durable medical equipment require a 20% coinsurance, and cardiac rehabilitation is not covered.
Inpatient Hospital See details
Inpatient hospital services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $350 copay per stay for acute care and a $300 daily copay for the first 5 days of a psychiatric stay, followed by no copay for days 6 through 90. While unlimited additional acute care days are covered, upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, featuring a $0 to $150 copay for outpatient hospital services and a $150 copay per stay for observation services. Ambulatory surgical center (ASC) and outpatient blood services are fully covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $20 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the HealthSpring Preferred (HMO) plan with a $175.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance and transportation services, with ground ambulance services requiring a $250 copay and no coinsurance, and air ambulance services requiring 20% coinsurance and no copay. Transportation benefits are partially covered, offering unlimited one-way trips to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related locations 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 limit with a $150 copay and no coinsurance per service.
Primary Care See details
HealthSpring Preferred (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and speech-language pathology require a $15 copay and no coinsurance. Additional telehealth services range from a $0 to $15 copay with no coinsurance, but chiropractic, podiatry, mental health specialty, and psychiatric services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, and kidney disease education. Uncovered services under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, and home-based palliative care.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams with a $15 copay and no coinsurance, and OTC hearing aids with a $399 copay and no coinsurance. Prescription hearing aids are partially covered with a copay between $399 and $1,800 and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by HealthSpring Preferred (HMO), which offers one routine eye exam annually with a $0 to $15 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $325 yearly maximum for contacts, upgrades, or one pair of frames and lenses.
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 $3,000 annual maximum.
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 and insulin, carry a coinsurance of 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization and a referral are required for these services.
Medical Equipment See details
HealthSpring Preferred (HMO) covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes, with prior authorization required. This benefit is partially covered because diabetic supplies are not covered, and other diabetic equipment is limited to specified manufacturers.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) partially covers diagnostic and radiological services with no coinsurance, though outpatient X-ray services are not covered. Covered lab services have no copay, diagnostic procedures and tests require a $0 to $150 copay, diagnostic radiology has a minimum copay of $0, and therapeutic radiology has a minimum copay of $85.
Home Health Services See details
HealthSpring Preferred (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required. This benefit ensures you can access necessary in-home medical care at no additional cost.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring Preferred (HMO) plan, as all individual sub-services are excluded from coverage. While the category technically features no coinsurance, specific treatments like intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100 per stay. Prior authorization is required, a prior three-day hospital stay is not necessary, 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), which offers over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $135 every three months for health-related items, and the meal benefit supports members recovering from medical conditions at home.
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