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HealthSpring Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Premier (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Premier (HMO-POS) in 2026, please refer to our full plan details page.
HealthSpring Premier (HMO-POS) is a HMO-POS plan offered by Health Care Service Corporation available for enrollment in 2025 to people living in Chicago. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HealthSpring Premier (HMO-POS) 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 Premier (HMO-POS).
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 Premier (HMO-POS), 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 $2900.00 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 Premier (HMO-POS) plan features an annual drug deductible of $200 before coverage begins. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, costing as low as $4 for a one-month supply at preferred locations and offering no copay for a three-month supply filled through preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs require a consistent $47 copay per month at both standard and preferred pharmacies. Tier 4 non-preferred drugs require a 50% coinsurance across all pharmacy options, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply.
Additional Benefits
HealthSpring Premier (HMO-POS) offers comprehensive medical coverage with no copay and no coinsurance for primary care visits and preventive services. For inpatient hospital stays, members pay a daily copay of $165 for days one through seven and no copay thereafter, while emergency room visits carry a $150 copay. Outpatient and specialist services are also highly accessible, featuring no coinsurance and minimal copays. This plan also includes key supplemental benefits, such as dental care with no copay for preventive services and an annual benefit maximum of $20,000. Vision and hearing benefits offer low copays for routine exams, alongside coverage for eyewear and hearing aids. Furthermore, members enjoy home health care and a quarterly over-the-counter allowance of $95 with no copays or coinsurance.
Inpatient Hospital See details
HealthSpring Premier (HMO-POS) partially covers inpatient hospital acute and psychiatric services with no coinsurance, though prior authorization is required. For both types of stays, you will pay a $165 daily copay for days 1 through 7 and no copay for days 8 through 90, while additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Premier (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $185 copay for outpatient hospital services and a $185 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $20 copay and no coinsurance.
Partial Hospitalization See details
HealthSpring Premier (HMO-POS) covers partial hospitalization services with an $85.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
HealthSpring Premier (HMO-POS) covers ground ambulance services with a $260 copay (no coinsurance) and air ambulance services with a 20% coinsurance (no copay), both requiring prior authorization. Transportation services are partially covered with no copay or coinsurance for up to 30 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Premier (HMO-POS) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $65 copay and no coinsurance, with 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 $50,000 maximum plan benefit.
Primary Care See details
HealthSpring Premier (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical and occupational therapy, telehealth, and opioid treatment require copays up to $20 with no coinsurance. Chiropractic, podiatry, mental health specialty, and psychiatric services are not covered, and prior authorization is required for most specialty care.
Preventive Services See details
HealthSpring Premier (HMO-POS) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, but sub-services such as health education, in-home safety assessments, and personal emergency response systems (PERS) are not covered.
Hearing Services See details
Hearing services are partially covered under HealthSpring Premier (HMO-POS), providing routine hearing exams and fitting evaluations for a $20 copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $1,800 copay and no coinsurance, but inner ear, outer ear, and over the ear models are not covered. OTC hearing aids are also covered with a $399 copay and no coinsurance for up to two devices per year.
Vision Services See details
HealthSpring Premier (HMO-POS) provides partially covered vision services, offering routine eye exams 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, up to a $225 annual maximum for contacts, upgrades, and one pair of eyeglasses.
Dental Services See details
HealthSpring Premier (HMO-POS) partially covers dental services up to a $20,000 annual maximum, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services have a $20 copay and no coinsurance, preventive services have no copay and no coinsurance, and covered comprehensive services require copays ranging from $0 to $675 with no coinsurance.
Home Infusion bundled Services See details
HealthSpring Premier (HMO-POS) covers Home Infusion bundled Services with no copay, requiring prior authorization and step therapy. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Premier (HMO-POS) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HealthSpring Premier (HMO-POS) partially covers Medical Equipment with no copay and a 20% coinsurance, with prior authorization required for services. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by HealthSpring Premier (HMO-POS), as outpatient X-ray services are not covered. Covered lab services have no copay or coinsurance, diagnostic tests require no coinsurance and a $0 to $50 copay, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
HealthSpring Premier (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Premier (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered with a $10 copay, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HealthSpring Premier (HMO-POS) with no coinsurance, featuring a $20 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a three-day prior hospital stay is not required for admission, additional days beyond the standard 100 days are not covered.
Other Services See details
HealthSpring Premier (HMO-POS) provides partial coverage for other services, which includes a meal benefit and over-the-counter (OTC) items up to $95 every three months, both available with no copay and no coinsurance. Acupuncture and other additional services are not covered under this benefit.
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