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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 $3200.00 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 plan features a $200 annual drug deductible before coverage begins. 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, costing as little as a $2 copay for a one-month supply at preferred locations, or no copay for a three-month supply via preferred mail order. Tier 3 preferred brand-name drugs require a flat $47 copay for a one-month supply across all pharmacy and mail-order options. Higher-tier medications require coinsurance rather than a copay, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive coverage with predictable costs, featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialized medical needs, members pay low copayments such as a $15 copay for specialist visits, routine hearing exams, and Medicare-covered dental services, alongside a $50 daily copay for the first 5 days of acute inpatient hospital stays. Diagnostic lab work and radiological services are also covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance. This plan also provides valuable supplemental benefits, including up to 40 free one-way transportation trips per year, an annual dental allowance of up to $3,750, and a $300 yearly eyewear allowance, all with no copay. Emergency services are covered with a $150 copay, which is waived if admitted within 24 hours, while urgent care visits require a $25 copay. Additionally, members receive home meals and a $100 quarterly over-the-counter allowance with no copay or coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient hospital services with no coinsurance, requiring a $50 daily copay for days 1 to 5 of acute stays and a $75 daily copay for days 1 to 5 of psychiatric stays, with no copay for days 6 to 90. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $125 copay and observation services with a $100 copay per stay. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse sessions require a $15 copay and no coinsurance.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $225 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, providing up to 40 one-way trips per year to plan-approved locations with no copay or coinsurance, while trips to any other health-related locations are not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $150 copay and urgently needed services with a $25 copay, both featuring no coinsurance and waived fees if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance, up to a maximum benefit limit of $50,000.
Primary Care See details
HealthSpring Preferred (HMO) features primary care physician services with no copay and no coinsurance, alongside specialist, physical therapy, and occupational therapy visits for a $15 copay and no coinsurance. Some psychiatric and mental health specialty services are covered with no copay and no coinsurance, though individual and group sessions, podiatry, and routine chiropractic services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams, fitness benefits, and kidney disease education, with no copay and no coinsurance. However, these additional preventive benefits are only partially covered, as services such as health education, in-home safety assessments, and personal emergency response systems (PERS) are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers annual routine hearing exams 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 copays ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Preferred (HMO) offers partially covered vision services, providing one routine eye exam per year with a $0 to $15 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear has no copay and no coinsurance, offering up to a $300 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $15 copay and no coinsurance, though prior authorization is required. Other preventive and comprehensive dental services are covered with no copay and no coinsurance, up to a maximum annual benefit of $3,750.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance and no copay, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under HealthSpring Preferred (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
HealthSpring Preferred (HMO) covers durable medical equipment, prosthetics, and diabetic therapeutic shoes with no copay and a 20% coinsurance, subject to prior authorization. This medical equipment benefit is partially covered, as diabetic supplies are not covered under the plan and diabetic equipment is limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring Preferred (HMO) with no coinsurance, requiring both prior authorization and referrals. There is no copay for lab and diagnostic radiological services, while diagnostic procedures and tests carry a copay of $0 to $150, therapeutic radiological services require a minimum copay of $85, and outpatient X-ray services are not covered.
Home Health Services See details
HealthSpring Preferred (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services under HealthSpring Preferred (HMO) feature no coinsurance, meaning some services are covered, but standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered in practice and require a $10 copay. Prior authorization and referrals are also required for these rehabilitation services.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 copay for days 1 through 20 and a $218 copay for days 21 through 100 per stay. Prior authorization is required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, offering a home meal benefit and up to $100 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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