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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 offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $200. After meeting this deductible, you will pay a $4 copay for Tier 1 preferred generic drugs at preferred pharmacies and mail-order, or a $20 copay at standard locations. Tier 2 standard generics require a $47 copay, while Tier 3 preferred brands and Tier 4 non-preferred drugs carry a 50% and 30% coinsurance, respectively. If you qualify for Extra Help, your Part D premium can be reduced to no cost. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive medical coverage featuring no copay for preventive services, annual physicals, and laboratory work. For inpatient hospital stays, members pay a $290 daily copay for the first six days and no copay for days 7 through 90, while specialist visits are highly affordable at a $10 copay. Emergency care carries a $130 copay, which is waived if admitted, and urgent care is available for a $50 copay. In addition to core medical care, the plan provides valuable extra benefits including a $350 annual eyewear allowance and up to $2,250 yearly for dental services. Members also benefit from a $90 quarterly over-the-counter allowance and a home meal program with no copay. Please note that certain services, such as cardiac rehabilitation and diabetic supplies, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by HealthSpring Preferred (HMO), requiring a $290 daily copay for days 1 through 6 and no copay for days 7 through 90, with no coinsurance. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, though prior authorization is required for most services. There is no copay for ambulatory surgical center services, while outpatient hospital visits range from a $0 to $295 copay, observation services require a $310 copay per stay, and outpatient substance abuse sessions carry 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
Ambulance and transportation services are partially covered by HealthSpring Preferred (HMO), as transportation services to health-related locations are not covered. Ground ambulance services require prior authorization and have a $250 copay with no coinsurance, while air ambulance services require prior authorization and have a 20% coinsurance with no copay.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 limit with a $130 copay and no coinsurance.
Primary Care See details
Primary Care benefits are partially covered by HealthSpring Preferred (HMO), with podiatry, routine chiropractic, mental health specialty, and psychiatric services not covered. Covered services feature no coinsurance, with copays ranging from no copay up to $10 for telehealth and other professionals, $10 for specialists, $15 for chiropractic care, and $20 for therapy and opioid treatment.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including Medicare-covered zero-dollar services with no copay or coinsurance, annual physicals, and kidney disease education. Additional preventive benefits are only partially covered; fitness programs and caregiver support are included, but sub-services like health education, weight management, therapeutic massage, and in-home safety assessments are not covered. Other services like glaucoma screenings and diabetes self-management are covered with no referral required.
Hearing Services See details
HealthSpring Preferred (HMO) covers annual hearing exams and fitting evaluations for a $10 copay and no coinsurance, alongside OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over-the-ear types are not covered.
Vision Services See details
HealthSpring Preferred (HMO) covers annual routine eye exams with a copay ranging from no copay to $15 and no coinsurance. The plan also provides a $350 annual allowance for eyewear, including contacts, eyeglasses, frames, and upgrades, with no deductible.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-approved dental services with a $10 copay and no coinsurance, subject to prior authorization. Additional dental services, including preventive, restorative, and orthodontic care, are also covered up to a maximum benefit of $2,250 every year.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with prior authorization, requiring a $35 copay and coinsurance ranging from no coinsurance to 20% for Part B insulin. 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. Prior authorization is required to access these covered services.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment, as diabetic supplies are not covered. Covered items, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts, require prior authorization and carry a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO) with no coinsurance, although prior authorization is required. There is no copay for lab services and outpatient X-rays, while copays range from $0 to $75 for diagnostic tests, $0 to $100 for diagnostic radiological services, and a flat $80 for therapeutic radiological services.
Home Health Services See details
HealthSpring Preferred (HMO) covers Home Health Services, though prior authorization is required before you can receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under HealthSpring Preferred (HMO), meaning there is no coverage, copay, or coinsurance for cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) partially covers Skilled Nursing Facility (SNF) services with prior authorization required, though additional days beyond Medicare-covered stays are not covered. For covered stays, there is no coinsurance, and you will pay a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100.
Other Services See details
Other Services are partially covered under HealthSpring Preferred (HMO), as acupuncture and dual eligible SNPs with highly integrated services are not covered. Covered benefits include a meal benefit for qualifying medical conditions and a $90 quarterly over-the-counter allowance, both offered with no copay or coinsurance.
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