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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 North Florida. This plan received an overall rating of 3.5 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 no drug deductible. Your prescription medication coverage will start immediately.
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 (HMO) Medicare plan features a $0 prescription drug deductible, allowing your coverage to begin immediately. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service, compared to a $10 copay for a one-month supply at standard pharmacies. Tier 2 generic medications cost as low as a $4 copay for a one-month supply at preferred locations, and you can even receive a three-month supply with no copay through preferred mail order. Tier 3 preferred brand drugs carry a consistent $47 copay for a one-month supply at both preferred and standard pharmacies. Higher-tier medications are subject to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 33% coinsurance for a one-month supply. Choosing preferred pharmacies and mail-order services with this plan can significantly lower your out-of-pocket prescription costs.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust medical coverage with no copay or coinsurance for primary care visits and preventive services, including annual physicals and fitness benefits. Specialist visits require a $30 copay, while inpatient hospital stays have a $295 daily copay for the first seven days and no copay for days eight through 90. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital, and urgent care visits carry a $50 copay. For specialty care, the plan features comprehensive dental coverage with no copay up to a $1,700 annual limit, alongside eyewear benefits with no copay up to a $250 yearly limit. Routine hearing exams and fittings require a $25 copay, with hearing aid copays ranging from $399 to $1,800 depending on the device. Additionally, members pay no copay or coinsurance for home health services and select diagnostic lab tests.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient hospital services with no coinsurance, requiring a $295 daily copay for days 1 through 7 and no copay for days 8 through 90. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which both feature no copay. Outpatient hospital services require a copay of $0 to $275, observation services require a $295 copay per stay, and outpatient substance abuse sessions have a $20 copay, with prior authorization required for most of these services.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance services with a $235 copay (and no coinsurance) for ground transport and a 20% coinsurance (and no copay) for air transport, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance up to a maximum benefit limit of $50,000.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Physical, occupational, and speech therapy require a $20 copay and no coinsurance, while podiatry is not covered. Chiropractic, psychiatric, and mental health specialty services are only partially covered, as routine chiropractic care, individual, and group sessions are not covered.
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 a fitness benefit. This benefit is partially covered as several additional services, such as health education, weight management, in-home safety assessments, and personal emergency response systems, are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers hearing services with no coinsurance, including annual routine hearing exams and fittings for a $25 copay. Hearing aids are partially covered up to two per year with a $399 copay for OTC devices and a $399 to $1,800 copay for prescription devices, 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 (HMO), offering one annual routine eye exam with a copay ranging from no copay to $20 and no coinsurance, though other eye exams are not covered. Eyewear is also covered with no copay, no coinsurance, and no deductible, providing up to a $250 yearly limit for contacts, frames, lenses, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services for a $30 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum annual benefit of $1,700. Covered services under this annual limit include oral exams, cleanings, x-rays, fluoride, endodontics, periodontics, implants, and orthodontics.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, although associated Medicare Part B drugs, including chemotherapy and radiation, carry no coinsurance to 20% coinsurance. Covered Medicare Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance, with prior authorization and step therapy required.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay, 20% coinsurance, and prior authorization requirements. Durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered under these terms, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays have no copay, while diagnostic procedures range from a $0 to $95 copay, diagnostic radiological services start at a $0 copay, and therapeutic radiological services have a minimum copay of $80.
Home Health Services See details
HealthSpring Preferred (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred (HMO) covers some Cardiac Rehabilitation Services with no coinsurance, but prior authorization is required. However, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered in practice and require a $10 copay.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, offering a meal benefit for chronic or homebound medical conditions with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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