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HealthSpring Achieve (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Achieve (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Achieve (HMO C-SNP) in 2026, please refer to our full plan details page.
HealthSpring Achieve (HMO C-SNP) is a HMO C-SNP plan offered by Health Care Service Corporation available for enrollment in 2026 to people living in Valley. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HealthSpring Achieve (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HealthSpring Achieve (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthSpring Achieve (HMO C-SNP).
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 Achieve (HMO C-SNP), 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 $3500.00 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 Achieve (HMO C-SNP) plan features an annual drug deductible of $200. You will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when utilizing a preferred pharmacy or preferred mail-order service. If you use standard pharmacies or standard mail-order options, copays start at $5 for Tier 1 and $10 for Tier 2 for a one-month supply. For Tier 3 preferred brand drugs, the plan requires a $47 copay for a one-month supply across all pharmacy and mail-order networks. Tier 4 non-preferred drugs carry a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance. Select diabetic drugs under Tier 6 are highly affordable, with copays starting at $9 at preferred pharmacies and preferred mail order.
Additional Benefits
The HealthSpring Achieve (HMO C-SNP) plan offers comprehensive coverage designed to keep out-of-pocket costs low, featuring no copay for primary care visits, preventive services, and home health care. Specialist visits, physical therapy, and routine dental, vision, and hearing exams are highly affordable, with copays of $10 or less. For inpatient hospital stays, members pay a $225 daily copay for the first seven days, after which there is no copay for the remainder of a standard Medicare-covered stay. Additional key benefits include no copay for routine dental care up to a $1,000 annual limit, a $200 annual allowance for eyewear with no copay, and no-copay transportation to plan-approved locations. Members also benefit from no copay on over-the-counter items with a $65 quarterly allowance, alongside standard 20% coinsurance for durable medical equipment and dialysis services. Emergency care is covered with a $150 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
Inpatient hospital care is covered by HealthSpring Achieve (HMO C-SNP) with no coinsurance, requiring a $225 daily copay for days 1 through 7 and no copay for days 8 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Achieve (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $20 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay of $0 to $175 and observation services carry a $175 copay per stay, with prior authorization required for most services.
Partial Hospitalization See details
HealthSpring Achieve (HMO C-SNP) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
HealthSpring Achieve (HMO C-SNP) covers ambulance services with prior authorization, requiring a $200 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are also partially covered with prior authorization, offering unlimited one-way trips to plan-approved locations with no copay or coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
HealthSpring Achieve (HMO C-SNP) covers emergency services with a $150 copay and urgently needed services with a $20 copay, with no coinsurance for either service 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 per service.
Primary Care See details
Primary care benefits under HealthSpring Achieve (HMO C-SNP) feature no copay and no coinsurance for primary care visits, and a $10 copay with no coinsurance for specialists, physical therapy, and occupational therapy. Chiropractic services are partially covered, offering routine care for a $20 copay and no coinsurance while excluding other chiropractic services, whereas mental health and psychiatric services are not covered. Podiatry, telehealth, and opioid treatment are also covered with copays ranging from $0 to $20 and no coinsurance.
Preventive Services See details
HealthSpring Achieve (HMO C-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive benefits are only partially covered, with services like health education, weight management programs, in-home safety assessments, and personal emergency response systems excluded from coverage.
Hearing Services See details
HealthSpring Achieve (HMO C-SNP) covers hearing services, including one routine hearing exam and fitting evaluation annually for a $10 copay and no coinsurance. Up to two OTC or prescription hearing aids are covered each year with no coinsurance, featuring a $399 copay for OTC models and a $399 to $1,800 copay for prescription models, though inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
HealthSpring Achieve (HMO C-SNP) partially covers vision services, which includes one annual routine eye exam with a $0 to $10 copay and no coinsurance, though other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance, providing up to a $200 annual maximum for contact lenses or one pair of eyeglasses per year.
Dental Services See details
HealthSpring Achieve (HMO C-SNP) covers Medicare-covered dental services with a $10 copay and no coinsurance, subject to prior authorization. Other preventive and comprehensive dental services, including cleanings, x-rays, and implants, are covered with no copay and no coinsurance up to a maximum annual plan benefit of $1,000.
Home Infusion bundled Services See details
HealthSpring Achieve (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
HealthSpring Achieve (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
HealthSpring Achieve (HMO C-SNP) covers durable medical equipment, prosthetic devices, and medical supplies with no copay, a 20% coinsurance, and prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services under HealthSpring Achieve (HMO C-SNP) are partially covered, with diagnostic procedures and tests not covered, while lab services are covered with no copay or coinsurance. Covered radiological services require prior authorization and carry no copay for diagnostic radiological services, a $10 copay for outpatient X-rays, and a 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the HealthSpring Achieve (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Achieve (HMO C-SNP) with no coinsurance, but require prior authorization. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
HealthSpring Achieve (HMO C-SNP) covers skilled nursing facility (SNF) care with no coinsurance, requiring a daily copay of $20 for days 1 to 20 and $218 for days 21 to 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
HealthSpring Achieve (HMO C-SNP) provides partially covered other services, including a meal benefit and over-the-counter (OTC) items with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive up to $65 every three months for OTC items, alongside home meal delivery for qualifying chronic or medical conditions.
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