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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 Alabama. 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 $4750.00 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 Enhanced Alternative drug benefit with a $200 annual prescription drug deductible. After meeting this deductible, Tier 1 preferred generic drugs require a $4 copay at preferred pharmacies and mail-order services, or a $20 copay at standard pharmacies. Tier 2 standard generics require a $47 copay, while Tier 3 preferred brands require 50% coinsurance and Tier 4 non-preferred drugs require 30% coinsurance. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and have no copay for covered Part D drugs. For those who qualify for the low-income subsidy, there is no cost for Part D coverage.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust coverage for essential medical needs, featuring specialist visits for a $10 copay and no coinsurance. Inpatient hospital stays require a $310 daily copay for the first 7 days, after which there is no copay for days 8 through 90. Outpatient care is also highly affordable, featuring no copay for ambulatory surgical center visits and outpatient hospital copays ranging from no copay up to $295. For supplemental care, the plan provides comprehensive dental benefits up to a $2,450 annual limit, alongside no copay for routine eyewear up to a $300 yearly maximum. Hearing exams require a $10 copay, while hearing aids are covered with copays ranging from $399 to $1,800. Additionally, emergency care is accessible worldwide for a $130 copay, ensuring peace of mind wherever you travel.
Inpatient Hospital See details
HealthSpring Preferred (HMO) offers partial coverage for inpatient hospital services, requiring a $310 daily copay for days 1 to 7, no copay for days 8 to 90, and no coinsurance. Prior authorization is required, and 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, including ambulatory surgical center visits with no copay and outpatient hospital services with a $0 to $295 copay. Observation services require a $310 copay per stay, while outpatient substance abuse sessions have a $20 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by HealthSpring Preferred (HMO) with a $140.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) partially covers ambulance and transportation services, requiring prior authorization for all ambulance transfers. Covered ground ambulance services require a $250 copay with no coinsurance, air ambulance services carry a 20% coinsurance with no copay, and transportation services to health-related locations are not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum benefit with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services, offers specialist visits for a $10 copay, and provides physical, occupational, and speech therapies for a $20 copay, all with no coinsurance. Additional telehealth and other healthcare professional services range from no copay to a $10 copay with no coinsurance, while opioid treatment requires a $20 copay with no coinsurance. Podiatry is not covered, and for chiropractic, psychiatric, and mental health specialty services, some services are covered but routine chiropractic care, individual sessions, and group sessions are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring Preferred (HMO) with no copays or coinsurance for Medicare-covered preventive care, annual physical exams, and kidney disease education. While select additional benefits like fitness programs and caregiver support are included, many other supplemental services such as health education, weight management, and nutritional therapy are not covered.
Hearing Services See details
Hearing services are partially covered by HealthSpring Preferred (HMO), offering annual routine exams and fitting evaluations for a $10 copay and no coinsurance. Up to two OTC hearing aids are covered for a $399 copay and prescription hearing aids (all types) are covered for a $399 to $1,800 copay with no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Preferred (HMO) covers one routine eye exam every year with a cost ranging from no copay to a $10 copay and no coinsurance. The plan also covers eyewear, including contacts, eyeglasses, and upgrades, with no copay or coinsurance up to a combined maximum benefit of $300 annually.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $10 copay and no coinsurance, requiring prior authorization. Additionally, a wide range of preventive, restorative, and orthodontic dental services are covered up to a maximum annual benefit of $2,450.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with prior authorization, featuring a $35 copay and no coinsurance to 20% coinsurance for Medicare Part B insulin. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Preferred (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with a 20% coinsurance and no copay for covered items, though prior authorization is required. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the HealthSpring Preferred (HMO) plan with no coinsurance, though prior authorization is required. There is no copay for lab services and outpatient x-rays, while diagnostic tests require a $0 to $75 copay, diagnostic radiological services carry a $0 to $100 copay, and therapeutic radiological services require an $80 copay.
Home Health Services See details
Home Health Services are covered under the HealthSpring Preferred (HMO) plan, though prior authorization is required before you can receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring Preferred (HMO) plan. This includes cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD), none of which are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by HealthSpring Preferred (HMO), with prior authorization required and no coverage provided for additional days beyond Medicare-covered stays. Covered services require a $10 copay with no coinsurance for days 1 to 20, and a $218 copay with no coinsurance for days 21 to 100.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, offering a limited-duration meal benefit and a $75 quarterly over-the-counter (OTC) allowance with no specified copays or coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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