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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 $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:
Sign up for HealthSpring Preferred (HMO)
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Drug Coverage
The HealthSpring Preferred (HMO) drug coverage features a drug deductible of $200. For Tier 1 preferred generic drugs, you will pay no copay when utilizing a preferred pharmacy or preferred mail order service. Tier 2 generic medications are also highly affordable, starting with a $2 copay for a one-month supply at preferred locations and no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs have a flat $47 copay for a one-month supply across all standard and preferred pharmacies or mail order options. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply. Choosing preferred pharmacies and mail-order services with this plan can significantly lower your out-of-pocket prescription costs.
Additional Benefits
HealthSpring Preferred (HMO) provides comprehensive medical coverage with no copays for primary care visits, preventive services, and home health care. For specialized medical care, members will find predictable costs, including a $15 copay for specialist visits, a $150 copay for emergency services, and daily inpatient hospital copays starting at $170. Most core outpatient and diagnostic services feature no coinsurance, keeping out-of-pocket costs highly manageable. This plan also offers valuable everyday health benefits, including dental services with no coinsurance and routine vision exams with no copay or low copays up to $15. Additionally, members can access unlimited transportation to plan-approved locations and a $105 quarterly over-the-counter item allowance with no copay. Essential medical equipment and specialized treatments like dialysis are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient hospital stays with no coinsurance, requiring a copay of $170 per day for days 1 to 6 of acute care and $195 per day for days 1 to 6 of psychiatric care, with no copay for days 7 to 90. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) outpatient services feature no coinsurance for all covered care, with no copays for ambulatory surgical center and blood services. Outpatient hospital copays range from $0 to $225, observation services cost a $225 copay per stay, and outpatient substance abuse sessions require a $30 copay.
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
Ambulance and transportation services are covered by HealthSpring Preferred (HMO), with ground ambulance services requiring a $230 copay (no coinsurance) and air ambulance services requiring a 20% coinsurance (no copay). Transportation is partially covered, offering unlimited rides to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $150 copay and urgently needed services with a $30 copay, both with no coinsurance and 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) provides primary care physician services with no copay and no coinsurance, while specialist, physical therapy, occupational therapy, and telehealth services require up to a $15 copay and no coinsurance. For chiropractic, psychiatric, and mental health benefits, some services are covered but routine chiropractic, other chiropractic, and individual or group sessions are not covered. Podiatry is not covered, while opioid treatment is available with a $30 copay and no coinsurance.
Preventive Services See details
HealthSpring Preferred (HMO) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and kidney disease education. Excluded from coverage are health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Hearing Services are covered by HealthSpring Preferred (HMO) with no deductibles or coinsurance, featuring a $15 copay for routine hearing exams (referral required) and a $399 copay for up to two OTC hearing aids per year. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800 for up to two aids per year, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO) because other eye exam services are not covered, though the plan features one routine eye exam per year with a $0 to $15 copay and no coinsurance. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $300 annual maximum for contacts or one pair of lenses and frames.
Dental Services See details
Dental services are partially covered by HealthSpring Preferred (HMO), with exclusions for maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental has a $15 copay and no coinsurance, while other covered preventive and comprehensive services feature no coinsurance and copays ranging from $0 to $675, up to a $20,000 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, have a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this benefit.
Medical Equipment See details
Medical Equipment is partially covered by HealthSpring Preferred (HMO) with no copay and 20% coinsurance, though prior authorization is required for most items. This benefit covers durable medical equipment, prosthetics, and diabetic therapeutic shoes, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring Preferred (HMO) with no coinsurance, as outpatient X-ray services are not covered. Covered lab services and diagnostic radiological services feature no copay, while diagnostic procedures and tests have a copay of $0 to $100, and therapeutic radiological services require a minimum copay of $85.
Home Health Services See details
HealthSpring Preferred (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HealthSpring Preferred (HMO) with no coinsurance, where some services are covered but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered and require a $15 copay. Prior authorization and referrals are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a daily copay of $20 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is 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 over-the-counter (OTC) items and meal benefits, though acupuncture is not covered. Eligible members receive up to $105 every three months for OTC items, as well as meals for qualifying chronic or medical conditions.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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