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HealthSpring Preferred Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Preferred Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Preferred Plus (HMO) in 2026, please refer to our full plan details page.
HealthSpring Preferred Plus (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 Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.00. 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 Plus (HMO) Medicare plan features an Enhanced Alternative drug benefit with a $200 prescription drug deductible. During the initial coverage phase, Tier 1 preferred generic drugs require a $4 copay at preferred pharmacies and mail-order services, or a $20 copay at standard pharmacies. Tier 2 standard generics carry a $47 copay, while Tier 3 preferred brands and Tier 4 non-preferred drugs require 50% and 30% coinsurance, respectively. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy can receive a premium reduction, paying $13.10 for Part D coverage.
Additional Benefits
The HealthSpring Preferred Plus (HMO) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits and low copays ranging from no copay to $15 for specialists. For hospital care, inpatient stays require a $275 copay for days one through seven and no copay for subsequent days, while outpatient hospital services range from no copay up to a $250 copay. Emergency room visits have a $130 copay and ground ambulance services require a $290 copay, with no coinsurance required for either service. This plan also includes key supplemental benefits, such as dental care up to a $2,000 annual maximum and routine vision exams, both with no copay or coinsurance. Routine hearing exams are available for a low $10 copay, while more specialized needs like durable medical equipment and dialysis require a 20% coinsurance. Additionally, members benefit from practical extras including a $50 quarterly over-the-counter allowance and up to ten free one-way trips per year to plan-approved locations with no copay.
Inpatient Hospital See details
HealthSpring Preferred Plus (HMO) partially covers inpatient acute and psychiatric hospital stays with a $275 copay for days 1 to 7, no copay for days 8 to 90, and no coinsurance. Prior authorization is required, and facility upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered.
Outpatient Services See details
HealthSpring Preferred Plus (HMO) covers outpatient services with no coinsurance, featuring a $0 to $250 copay for outpatient hospital services and a $250 copay per stay for observation services. Ambulatory surgical center services are covered with no copay, while outpatient substance abuse sessions require a $15 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by HealthSpring Preferred Plus (HMO) with a copay of $140.00 and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring Preferred Plus (HMO), with ground ambulance services requiring a $290 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Transportation benefits are partially covered, offering up to 10 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred Plus (HMO) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum limit with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred Plus (HMO) covers primary care physician visits with no copay and no coinsurance, while other services like specialist visits and physical therapy require copays from $0 to $15 with no coinsurance. Podiatry is not covered, chiropractic services are partially covered as routine care is not covered, and while some mental health and psychiatric services are covered, individual and group sessions are not.
Preventive Services See details
HealthSpring Preferred Plus (HMO) covers preventive services, including annual physical exams, fitness benefits, and caregiver support, with no copay and no coinsurance for Medicare-covered zero-dollar services. However, these benefits are only partially covered, as services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring Preferred Plus (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 prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by HealthSpring Preferred Plus (HMO), featuring yearly routine eye exams with no coinsurance and a copay ranging from no copay to $10. Eyewear is also covered up to a $250 annual maximum with no deductible, copay, or coinsurance.
Dental Services See details
HealthSpring Preferred Plus (HMO) covers dental services, including Medicare-covered dental care which requires a $10 copay and no coinsurance. Other preventive, comprehensive, and orthodontic services are covered up to a $2,000 annual maximum with no copay and no coinsurance.
Home Infusion bundled Services See details
HealthSpring Preferred Plus (HMO) covers Home Infusion bundled Services with prior authorization, including chemotherapy, radiation, insulin, and other Part B drugs. Medicare Part B Insulin Drugs require a $35 copay and no coinsurance to 20% coinsurance, while other Part B chemotherapy, radiation, and miscellaneous drugs require no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Preferred Plus (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
HealthSpring Preferred Plus (HMO) partially covers medical equipment, requiring no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes. Prior authorization is required for these covered services, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred Plus (HMO) with no coinsurance, though prior authorization is required. Lab and outpatient X-ray services have no copay, while diagnostic tests cost up to $75, diagnostic radiology costs up to $100, and therapeutic radiology requires an $80 copay.
Home Health Services See details
Home health services are covered by the HealthSpring Preferred Plus (HMO) plan, though prior authorization is required before you can receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered under the HealthSpring Preferred Plus (HMO) plan, meaning some services are covered, though in practice, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. Because these specific services are not covered, there are no copay or coinsurance benefits available.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred Plus (HMO) partially covers Skilled Nursing Facility (SNF) services with prior authorization, though additional days beyond the Medicare-covered limit are not covered. Stays require 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 Plus (HMO) partially covers Other Services, which include a $50 quarterly over-the-counter item allowance and limited-duration meal benefits for qualifying medical conditions. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered under this plan.
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