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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 drug benefit with a $200.00 annual prescription drug deductible. In the initial coverage phase, Tier 1 preferred generic drugs require a $4.00 copay at preferred pharmacies or a $20.00 copay at standard pharmacies. Tier 2 standard generic drugs carry a $47.00 copay, while Tier 3 preferred brands and Tier 4 non-preferred drugs require 50% and 30% coinsurance, respectively. If you qualify for the low-income subsidy, your Part D premium is reduced to no cost. Additionally, once your yearly out-of-pocket drug costs reach $2,100.00, you will enter the catastrophic coverage phase and have no copay for covered Part D prescription drugs.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive medical coverage with fixed cost-sharing for key healthcare services. Inpatient hospital stays require a $310 daily copay for days one through seven, followed by no copay for days eight through 90, while specialist visits require a $15 copay. Additionally, emergency room visits carry a $130 copay, and skilled nursing facility stays require a $10 daily copay for the first 20 days. Supplemental benefits include preventive care, annual physicals, lab tests, and x-rays with no copays or coinsurance. Dental and vision benefits are highly accessible, featuring no copays or coinsurance for routine dental up to a $2,150 annual maximum and no copay for eyewear up to a $250 limit. Hearing exams are available for a $15 copay, while medical equipment and dialysis services generally require a 20 percent coinsurance.
Inpatient Hospital See details
Inpatient hospital benefits are covered by HealthSpring Preferred (HMO) and require a $310 daily copay for days 1 through 7, no copay for days 8 through 90, and no coinsurance. Prior authorization is required, and some services are not covered, including upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center services and no deductible for blood services. Outpatient hospital services require a copay between $0 and $295, while outpatient substance abuse sessions have a $20 copay and observation services require a $310 copay per stay.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization benefits with a $140 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by HealthSpring Preferred (HMO), with prior authorization required for all ambulance services. Ground ambulance services require a $250 copay and no coinsurance, and air ambulance services require 20% coinsurance and no copay, while transportation services to plan-approved or any 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 with a $130 copay and no coinsurance.
Primary Care See details
Primary care benefits are offered by HealthSpring Preferred (HMO) with no coinsurance, featuring a $15 copay for specialists, a $20 copay for therapy and opioid treatment, and copays ranging from no copay to $15 for telehealth and other healthcare professionals. Podiatry, routine chiropractic care, and both individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) offers coverage for preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered, providing fitness benefits and caregiver support, while sub-services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers annual hearing exams and fitting evaluations for a $15 copay and no coinsurance, as well as 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 prescription hearing aids 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. Eyewear, including contacts, lenses, and frames, is covered up to a $250 annual maximum with no copay, no coinsurance, and no deductible.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $15 copay and no coinsurance, subject to prior authorization. Other preventive and comprehensive dental services, including cleanings, x-rays, and orthodontics, are covered with no copays or coinsurance up to a maximum annual benefit of $2,150.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with prior authorization, featuring no copay and no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with a 20% coinsurance and no copay, although prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered by HealthSpring Preferred (HMO), offering covered items with no copay and a 20% coinsurance. Covered services include durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, subject to prior authorization. Lab and outpatient X-ray services have no copay, while other diagnostic and radiological services require copays ranging from no copay up to $100.
Home Health Services See details
Home Health Services are covered under the HealthSpring Preferred (HMO) plan, though prior authorization is required before receiving these services.
Cardiac Rehabilitation Services See details
HealthSpring Preferred (HMO) does not cover Cardiac Rehabilitation Services. There is no copay or coinsurance coverage available for cardiac, intensive cardiac, pulmonary, or SET for PAD rehabilitation services under this plan.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) partially covers Skilled Nursing Facility (SNF) services, requiring prior authorization and excluding coverage for additional days beyond the Medicare-covered limit. For covered stays, there is no coinsurance, but you will pay a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, which features a $25 quarterly allowance for over-the-counter items and a limited-duration meal benefit for certain medical conditions with no copay or coinsurance. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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