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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 $4900.00 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 prescription drug benefit with an annual deductible of $200.00. Individuals who qualify for Extra Help or the low-income subsidy will pay no premium for Part D coverage. After meeting the deductible, members enter the initial coverage phase until total combined drug costs reach $2,100.00. During the initial phase, a 30-day supply of Tier 1 preferred generics has a $4.00 copay at preferred locations and a $20.00 copay at standard locations. Tier 2 standard generics require a $47.00 copay, while Tier 3 preferred brands and Tier 4 non-preferred drugs carry a 50% and 30% coinsurance, respectively. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive coverage for core medical needs, featuring no coinsurance for inpatient hospital stays, outpatient services, and emergency care. Inpatient stays require daily copays for the first several days, while emergency visits require a $130 copay and urgent care has a $50 copay. Specialist visits require a $10 copay, and diagnostic services like lab tests and x-rays are available with no copay. This plan also includes valuable supplemental benefits, such as preventive dental services covered up to a $1,650 annual limit and a $300 yearly allowance for eyewear with no copay. Routine hearing exams carry a $10 copay, and members receive a $70 quarterly allowance for over-the-counter health items. For specialized needs like durable medical equipment and dialysis, members will pay a 20% coinsurance with no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $280 for days 1 through 6 of acute stays and $295 for days 1 through 7 of psychiatric stays, with no copay for subsequent days. Sub-services such as non-Medicare-covered stays, hospital upgrades, and additional days for psychiatric stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center services and a $25 copay for outpatient substance abuse sessions. Outpatient hospital services range from no copay to a $299 copay, while observation services require a $299 copay per stay.
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 to access these services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) partially covers Ambulance and Transportation Services, as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a $285 copay and no coinsurance, while air ambulance services require no copay and a 20% coinsurance.
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 with a $130 copay and no coinsurance, up to a maximum plan benefit of $50,000.
Primary Care See details
Primary care benefits are offered by HealthSpring Preferred (HMO) with no coinsurance, featuring a $10 copay for specialists, a $25 copay for physical and occupational therapies, and no copay to $10 for telehealth. Chiropractic services are partially covered with a $15 copay, excluding routine care, while podiatry is not covered, and some mental health and psychiatric services are covered but individual and group sessions are not.
Preventive Services See details
HealthSpring Preferred (HMO) covers Medicare-covered zero-dollar preventive services, annual physical exams, and kidney disease education with no copay and no coinsurance. Additional preventive services are partially covered, offering fitness benefits and caregiver support, while sub-services like health education, weight management, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered by HealthSpring Preferred (HMO), with no coverage for inner ear, outer ear, and over the ear prescription hearing aids. Routine exams and fittings require a $10 copay, while OTC hearing aids have a $399 copay and covered prescription hearing aids carry a copay between $399 and $1,800, all with no coinsurance.
Vision Services See details
HealthSpring Preferred (HMO) covers vision services, including one annual routine eye exam with a copay ranging from no copay to $25 and no coinsurance. The plan features no deductible and offers up to $300 in annual coverage for eyewear, including contacts, frames, and upgrades, with no copay or coinsurance.
Dental Services See details
HealthSpring Preferred (HMO) covers dental services, including Medicare-covered dental care which requires prior authorization and has a $10 copay and no coinsurance. Other preventive and comprehensive dental services, such as cleanings, x-rays, and orthodontics, are covered up to a maximum benefit of $1,650 every year.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with prior authorization, requiring a $35 copay and coinsurance ranging from no coinsurance to 20% for Part B insulin drugs. Other covered Part B chemotherapy, radiation, and miscellaneous drugs require no copay and carry a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with a 20% coinsurance and no copay, though prior authorization is required.
Medical Equipment See details
Medical Equipment is partially covered by HealthSpring Preferred (HMO), requiring a 20% coinsurance and no copay for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Diabetic supplies are not covered, and prior authorization is required for covered services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO) with no coinsurance, although prior authorization is required. Lab services and outpatient x-rays require no copay, while diagnostic procedures cost between $0 and $75, diagnostic radiology ranges from $0 to $100, and therapeutic radiology has 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 services can be received.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSpring Preferred (HMO) plan, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation. Since these services are not covered, there are no associated copays or coinsurance.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) partially covers skilled nursing facility (SNF) services, requiring prior authorization but no coinsurance. Covered stays carry a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though 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 for qualifying medical conditions and a $70 quarterly over-the-counter (OTC) allowance with no copay or coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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