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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
HealthSpring Preferred Plus (HMO) offers an Enhanced Alternative prescription drug benefit with an annual deductible of $200.00. During the initial coverage phase, Tier 1 preferred generic drugs cost a low $4.00 copay at preferred pharmacies and mail-order services, or a $20.00 copay at standard pharmacies. Tier 2 standard generics require a $47.00 copay, while Tier 3 preferred brands and Tier 4 non-preferred drugs carry a 50% and 30% coinsurance respectively. After your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase where you pay nothing for covered Part D prescription drugs. Additionally, individuals who qualify for the low-income subsidy, or Extra Help, may see their Part D premium reduced to $13.10. This HMO plan provides structured cost-sharing to help you manage your healthcare expenses effectively.
Additional Benefits
HealthSpring Preferred Plus (HMO) offers comprehensive medical coverage with predictable costs, featuring no copay up to a $10 copay for primary care and specialist visits. For inpatient hospital stays, members pay a $275 daily copay for days one through seven and no copay for days eight through 90, with no coinsurance. Outpatient hospital services require copays up to $250, while emergency room visits carry a $130 copay and urgent care costs $50. This plan also includes key supplemental benefits, such as up to $1,750 in annual dental coverage and a $250 yearly allowance for eyewear with no coinsurance. Routine vision and hearing exams are highly affordable, ranging from no copay to a $10 copay, and members receive a $25 quarterly allowance for over-the-counter items. Additionally, services like dialysis and medical equipment are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HealthSpring Preferred Plus (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 through 7 and no copay for days 8 through 90. Hospital upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered under this benefit.
Outpatient Services See details
HealthSpring Preferred Plus (HMO) covers outpatient services with no coinsurance, featuring copays ranging from no copay for ambulatory surgical center services up to $250 for outpatient hospital and observation services. Outpatient substance abuse sessions carry a $10 copay, and prior authorization is required for most of these covered services.
Partial Hospitalization See details
HealthSpring Preferred Plus (HMO) covers partial hospitalization benefits with a $140.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
HealthSpring Preferred Plus (HMO) covers ground ambulance services with a $255 copay and no coinsurance, and air ambulance services with 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 with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with a $130 copay.
Primary Care See details
HealthSpring Preferred Plus (HMO) partially covers Primary Care benefits with no coinsurance and copays ranging from no copay up to $10 for services like primary care visits, specialist consultations, and therapies. Podiatry, chiropractic, mental health specialty, and psychiatric services are not covered under this plan.
Preventive Services See details
HealthSpring Preferred Plus (HMO) covers preventive services, offering annual physicals, kidney education, and Medicare-covered zero-dollar services with no copay and no coinsurance. However, additional preventive benefits are only partially covered, excluding 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.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred Plus (HMO), featuring a $10 copay and no coinsurance for annual routine exams and fitting evaluations. 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. Over-the-counter hearing aids are also available with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring Preferred Plus (HMO) covers annual routine eye exams with a copay ranging from no copay to $10 and no coinsurance. The plan also covers eyewear, including eyeglasses and contact lenses, up to a combined maximum of $250 per year with no deductible and no coinsurance.
Dental Services See details
Dental services are covered by HealthSpring Preferred Plus (HMO), including Medicare-covered dental services which require prior authorization and have a $10 copay and no coinsurance. A wide range of preventive, comprehensive, and orthodontic dental services are also covered up to an annual maximum benefit of $1,750.
Home Infusion bundled Services See details
HealthSpring Preferred Plus (HMO) covers Home Infusion bundled Services with prior authorization, featuring no coinsurance to 20% coinsurance and no copay for Part B chemotherapy, radiation, and other Part B drugs. Covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred Plus (HMO) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment benefits are covered by HealthSpring Preferred Plus (HMO) with a 20% coinsurance and no copay, though prior authorization is required. This benefit is partially covered, as diabetic supplies are not covered under the plan.
Diagnostic and Radiological Services See details
HealthSpring Preferred Plus (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab and outpatient X-ray services, an $80 copay for therapeutic radiological services, and copays ranging up to $75 for diagnostic tests and $100 for diagnostic radiological services.
Home Health Services See details
Home health services are covered under the HealthSpring Preferred Plus (HMO) plan, but prior authorization is required before receiving care.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are listed with some services covered under HealthSpring Preferred Plus (HMO), but in practice, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, leaving members with no copay or coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by HealthSpring Preferred Plus (HMO) with prior authorization required, as additional days beyond the Medicare-covered limit are not covered. Patients will pay a $10.00 daily copay for days 1 through 20 and a $218.00 daily copay for days 21 through 100, with no coinsurance.
Other Services See details
HealthSpring Preferred Plus (HMO) partially covers Other Services, providing a $25 quarterly over-the-counter item allowance and limited-duration meal benefits with no copay or coinsurance. Acupuncture and Dual Eligible SNPs with highly integrated services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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