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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 Chicago. 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 $2000.00 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 annual drug deductible of $200. For Tier 1 preferred generic and Tier 2 generic medications, there is no copay when using a preferred pharmacy or preferred mail order service for up to a three-month supply. If you use a standard pharmacy or standard mail order, Tier 1 drugs require a copay starting at $5 for a one-month supply, while Tier 2 drugs start at a $10 copay. For Tier 3 preferred brand drugs, members pay a flat $47 copay for a one-month supply across all pharmacy and mail order channels. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance for a one-month supply. This structure helps beneficiaries manage prescription costs through preferred networks and generic drug options.
Additional Benefits
HealthSpring Preferred (HMO) offers comprehensive coverage with low out-of-pocket costs for essential medical services. For inpatient hospital stays, members pay a daily copay of $125 for the first seven days and no copay thereafter, while primary care visits, preventive services, and home health care are available with no copay or coinsurance. Urgent care and emergency services feature copays of $65 and $150 respectively, with no coinsurance, and emergency copays are waived if you are admitted. The plan also provides valuable supplemental benefits, including dental care up to a $20,000 annual limit and vision eyewear with up to a $350 annual allowance, both featuring options with no copay. Additionally, members benefit from no copay on routine hearing exams, a quarterly allowance of $185 for over-the-counter items, and no copay for up to 24 one-way transportation trips per year. For medical equipment and dialysis services, members can expect a 20% coinsurance and no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $125 daily copay for days 1 through 7 and no copay for days 8 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $135 copay, observation services require a $135 copay per stay, and outpatient substance abuse sessions have a $15 copay, all with no coinsurance.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $100.00 copay and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $260 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 24 plan-approved one-way trips per year, though transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $150 copay and urgently needed services with a $65 copay, with no coinsurance for either and copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum limit with a $150 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) provides primary care, mental health, and psychiatric services with no copay and no coinsurance, though routine chiropractic, podiatry, and individual or group therapy sessions are not covered. Specialist visits, physical, occupational, and speech therapies, opioid treatment, and telehealth services are covered with no coinsurance and copays ranging from no copay to $15.
Preventive Services See details
Preventive services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive services are partially covered; fitness and caregiver benefits are included, but health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by HealthSpring Preferred (HMO), offering annual routine exams and fittings for a $15 copay and no coinsurance. Up to two hearing aids are covered per year with no coinsurance, featuring a $399 to $1,800 copay for prescription aids and a $399 copay for OTC aids, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Preferred (HMO) provides partially covered vision services, including one routine eye exam per year with a $0 to $15 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering up to a $350 annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) partially covers dental services up to a $20,000 annual maximum with no coinsurance. Preventive options and oral surgery feature no copay, Medicare-covered dental has a $15 copay, and other comprehensive services require copays from $0 to $675, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with no copay, although prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and medical supplies, with no copay and a 20% coinsurance, though prior authorization is required. Diabetic equipment is partially covered under this plan, offering therapeutic shoes and inserts with no copay and 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO) with prior authorization required. Diagnostic services have no coinsurance, featuring no copay for lab services and a $0 to $25 copay for other diagnostic procedures, while radiological services require a minimum 20% coinsurance for therapeutic services and no copay for outpatient X-rays and diagnostic radiology.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred (HMO) covers some services under Cardiac Rehabilitation Services with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. Prior authorization is required for covered services.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 daily copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, but a prior three-day hospital stay is not necessary, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The plan provides up to $185 every three months for OTC items and offers a meal benefit for chronic illnesses or medical conditions requiring you to stay at home.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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