A non-government entity
HealthSpring Alliance (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Alliance (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Alliance (HMO) in 2026, please refer to our full plan details page.
HealthSpring Alliance (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Houston. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HealthSpring Alliance (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 Alliance (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 Alliance (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 $2900.00 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 Alliance (HMO) prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay when using preferred pharmacies or preferred mail order services. If you use standard pharmacies or standard mail order, Tier 1 copays start at $5 and Tier 2 copays start at $10 for a one-month supply. Tier 3 preferred brand drugs have a consistent $47 copay for a one-month supply across all pharmacy and mail order options. For higher-tier medications, Tier 4 non-preferred drugs require a 50% coinsurance and Tier 5 specialty drugs require a 30% coinsurance.
Additional Benefits
The HealthSpring Alliance (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care physician visits and a low $10 copay for specialists. Inpatient acute hospital stays require a $225 copay per stay with no coinsurance, while emergency room visits carry a $150 copay that is waived if you are admitted. Outpatient hospital visits range from no copay up to a $125 copay, and urgent care visits require just a $10 copay. For supplemental care, the plan provides preventive and comprehensive dental services with no copay up to a $3,000 annual limit, as well as a $400 annual eyewear allowance with no copay. Routine hearing exams require a $10 copay, while diagnostic lab services and home health care are available with no copay. Members also receive valuable extra benefits with no copay, including home-delivered meals for chronic conditions and up to $170 every three months for over-the-counter items.
Inpatient Hospital See details
HealthSpring Alliance (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $225 copay per stay for acute care and a $125 daily copay for days 1 through 4 (and no copay for days 5 through 90) for psychiatric care. Upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Alliance (HMO) outpatient services are covered with no coinsurance, featuring a $0 to $125 copay for outpatient hospital visits and a $140 copay per stay for observation services. Members pay no copay for ambulatory surgical center or outpatient blood services, while individual and group outpatient substance abuse sessions require a $10 copay.
Partial Hospitalization See details
HealthSpring Alliance (HMO) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HealthSpring Alliance (HMO) covers ground ambulance services with a $235 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay and no coinsurance for unlimited one-way trips to plan-approved locations, though transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Alliance (HMO) emergency services are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $10 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
HealthSpring Alliance (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $10 copay and no coinsurance. Physical, occupational, and speech therapies require a $25 copay and no coinsurance, while podiatry is not covered, and some chiropractic, mental health, and psychiatric services are covered with up to a $10 copay and no coinsurance but exclude routine, individual, and group sessions.
Preventive Services See details
HealthSpring Alliance (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams and kidney disease education. Additional preventive services are partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy-related wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, smoking cessation counseling, disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
Hearing Services under HealthSpring Alliance (HMO) include annual routine exams and fitting evaluations for a $10.00 copay and no coinsurance, subject to a referral. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399.00 to $1,800.00, excluding inner ear, outer ear, and over the ear models. OTC hearing aids are also covered with a $399.00 copay and no coinsurance, with a limit of two devices per year.
Vision Services See details
Vision services are partially covered by HealthSpring Alliance (HMO), featuring routine eye exams with a $0 to $10 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $400 annual limit for contacts, lenses, frames, and upgrades.
Dental Services See details
HealthSpring Alliance (HMO) offers Medicare-covered dental services for a $10 copay and no coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance, up to a maximum annual plan benefit of $3,000.
Home Infusion bundled Services See details
HealthSpring Alliance (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Medicare Part B insulin drugs carry a $35 copay and between no coinsurance and 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Alliance (HMO) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these services.
Medical Equipment See details
HealthSpring Alliance (HMO) partially covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. Under this benefit, durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by HealthSpring Alliance (HMO) with no coinsurance, though prior authorization and referrals are required. Lab services have no copay, outpatient x-rays have a $10 copay, diagnostic procedures and tests range from a $0 to $50 copay, and therapeutic radiological services require a minimum copay of $85.
Home Health Services See details
HealthSpring Alliance (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Alliance (HMO) covers Cardiac Rehabilitation Services with no coinsurance, but requires prior authorization and a referral. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
HealthSpring Alliance (HMO) covers Skilled Nursing Facility (SNF) services 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 while a prior three-day inpatient hospital stay is not necessary, additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services under the HealthSpring Alliance (HMO) are partially covered, offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. The plan provides up to $170 every three months for OTC items and delivers meals to members with chronic illnesses or medical conditions that require them to remain at home.
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