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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 Corpus Christi. 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 $2300.00 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 a $200 drug deductible and offers cost-effective coverage for generic medications. You will pay no copay for Tier 1 preferred generics and Tier 2 generics when using a preferred pharmacy or preferred mail order. If you utilize standard pharmacies or standard mail order services, one-month copays are $5 for Tier 1 and $10 for Tier 2. 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. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply.
Additional Benefits
HealthSpring Preferred (HMO) offers comprehensive medical coverage featuring no copays for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $50 copay per day for the first five days and no copay thereafter, while specialist visits and routine dental services require a low $20 copay. Emergency care is available with a $150 copay, and urgent care visits cost $25, with both fees waived if you are admitted to the hospital. The plan also includes valuable supplemental benefits, including up to $3,100 annually for preventive and comprehensive dental care with no copays, and a $250 annual allowance for eyewear with no copay or deductible. Additionally, members can access up to 50 free one-way transportation trips per year to approved locations and receive a $90 quarterly over-the-counter allowance with no copay. Other specialized services, such as dialysis and durable medical equipment, are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) inpatient hospital services are partially covered with no coinsurance, requiring a $50 copay for days 1 to 5 and no copay for days 6 to 90 per stay. 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 no copays for ambulatory surgical center (ASC) and outpatient blood services. Copayments range from $0 to $50 for outpatient hospital services, $50 per stay for observation services, and $20 per session for outpatient substance abuse services, with prior authorization or referrals required for certain benefits.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $175 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $180 copay (no coinsurance) and air ambulance services with a 20% coinsurance (no copay). Transportation benefits are partially covered, providing up to 50 one-way trips per year 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 $25 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 with a $150 copay and no coinsurance, up to a maximum benefit limit of $50,000.
Primary Care See details
HealthSpring Preferred (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and opioid treatment require a $20 copay and no coinsurance. Additional telehealth and other healthcare professional services range from no copay to a $20 copay with no coinsurance, but podiatry is not covered, and chiropractic, mental health, and psychiatric benefits exclude routine care as well as individual and group sessions.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, though health education, PERS, in-home safety assessments, medical nutrition therapy, weight management, alternative therapies, and home-based palliative care are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) offers hearing services featuring a $20 copay and no coinsurance for routine exams and fittings, which require a referral. Hearing aid coverage is partially covered with no coinsurance, requiring a $399 copay for OTC models and copays from $399 to $1,800 for prescription models, though 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), offering one routine eye exam per year with a $0 to $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $250 annual maximum allowance for contact lenses or one pair of eyeglasses.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare dental services with a $20 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum benefit of $3,100 every year. Covered dental services include oral exams, cleanings, x-rays, endodontics, periodontics, and implants.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, have no copay and a coinsurance ranging from no coinsurance up to 20%, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and a 20% coinsurance, requiring prior authorization for durable medical equipment, prosthetic devices, and diabetic therapeutic shoes. Diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring Preferred (HMO) with no coinsurance, although prior authorization and referrals are required. Members pay no copay for lab and diagnostic radiological services, while diagnostic procedures carry a copay of $0 to $150, therapeutic radiological services require a minimum $85 copay, 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 are covered by HealthSpring Preferred (HMO) with a $10 copay and no coinsurance. Although some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered in practice.
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 to 20 and a $218 copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, providing a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit includes a maximum coverage of $90 every three months, which does not carry forward if unused.
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