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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) plan features an annual drug deductible of $200. Under this plan, you can benefit from no copay on 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 $2 at preferred pharmacies and preferred mail order, while standard pharmacies charge a $10 copay for a one-month supply. For Tier 3 preferred brand drugs, you will pay a flat $47 copay for a one-month supply across all pharmacy and mail order options. Higher-tier medications require coinsurance rather than a flat copay, with Tier 4 non-preferred drugs costing 50% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers affordable healthcare coverage with no copay or coinsurance for primary care visits, annual physicals, and preventive services. Specialists, physical therapy, and occupational therapy require a low $15 copay, while inpatient hospital stays feature a $50 daily copay for the first five days. Emergency room visits have a $150 copay, which is waived if admitted, and urgent care is available with a $25 copay. This plan also includes valuable supplemental benefits, such as dental care with no copay up to a $2,700 annual limit and a $200 yearly allowance for eyewear with no copay. Members also benefit from unlimited transportation to plan-approved locations and an over-the-counter allowance of $85 every three months with no copay. Hearing exams are covered with a $15 copay, and hearing aids are available with copays starting at $399.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient hospital services with no coinsurance, requiring a $50 daily copay for days 1 through 5 of acute stays and a $100 daily copay for days 1 through 5 of psychiatric stays, with no copay for days 6 through 90. The benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, featuring a $0 to $125 copay for outpatient hospital services and a $125 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $15 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $175.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $150 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Unlimited transportation to plan-approved health-related locations is covered with no copay or coinsurance, though 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 with a $150 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $15 copay and no coinsurance. Some chiropractic, mental health, and psychiatric services are covered with no coinsurance, but routine chiropractic care, other chiropractic services, and individual or group therapy sessions are not covered, and podiatry is excluded.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, fitness benefits, and kidney disease education. Additional preventive services are partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, 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, disease management, telemonitoring, remote access, home safety modifications, and counseling. Referrals are required for kidney disease education and digital rectal exams.
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 copays ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
HealthSpring Preferred (HMO) partially covers vision services, excluding other eye exam services but covering one routine eye exam annually with a $0 to $15 copay and no coinsurance. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $200 annual maximum benefit for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers preventive and comprehensive dental services with no copay and no coinsurance, up to a maximum annual benefit of $2,700. Medicare-covered dental services are also covered with a $15 copay and no coinsurance.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs are covered with a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive these services.
Medical Equipment See details
HealthSpring Preferred (HMO) covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered, as durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services under HealthSpring Preferred (HMO) are partially covered with no coinsurance, requiring prior authorization and referrals. Lab services and diagnostic radiological services have no copay, diagnostic procedures and tests have a copay ranging from $0 to $125, therapeutic radiological services have a minimum $85 copay, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the HealthSpring Preferred (HMO) plan 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 and a $15 copay, though only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, and any covered services require a referral and prior authorization.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100 per stay. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, offering 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 $85 every three months for select health items, but unused balances do not roll over.
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