A non-government entity
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 Orlando. 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 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:
Sign up for HealthSpring Preferred (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HealthSpring Preferred (HMO) plan features a $200 drug deductible and offers savings on generic medications. Tier 1 preferred generic drugs have no copay when filled through preferred pharmacies or preferred mail order, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic drugs cost as little as a $4 copay for a one-month supply at preferred pharmacies, with no copay for a three-month supply ordered through preferred mail delivery. For brand-name and specialty medications, the plan transitions to higher copays and coinsurance rates. Tier 3 preferred brand drugs require a $47 copay for a one-month supply across all pharmacy and mail order types, whereas Tier 4 non-preferred drugs carry a 50% coinsurance. Specialty tier drugs in Tier 5 are covered with a 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, while specialist visits require up to a $10 copay. Inpatient hospital stays feature no coinsurance and a $75 daily copay for the first five days, followed by no copay for days six through 90. Emergency care is available with a $150 copay, and urgent care visits require a low $10 copay, both with no coinsurance. For extra benefits, members enjoy no copay and no coinsurance on preventive and comprehensive dental services up to a $2,050 annual limit, alongside no copay for eyewear up to a $350 yearly maximum. Routine hearing exams carry a $10 copay, while over-the-counter hearing aids require a $399 copay with no coinsurance. Additionally, the plan provides home health services and up to $205 every three months for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $75 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional days are covered for acute stays, additional psychiatric 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 copay of $0 to $40 (including a $40 copay per stay for observation services), while individual and group outpatient substance abuse sessions have a $10 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the HealthSpring Preferred (HMO) plan with a $100.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $280 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services 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 (HMO) covers emergency services with a $150 copay and urgently needed services with a $10 copay, both with no coinsurance and cost-sharing that does not count toward the plan deductible. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum benefit with a $150 copay and no coinsurance per service.
Primary Care See details
HealthSpring Preferred (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, and telehealth visits require a $0 to $10 copay and no coinsurance. Mental health and psychiatric services have a $30 copay and no coinsurance, but podiatry is not covered and chiropractic services are only partially covered, with routine and other chiropractic services excluded from coverage.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and a fitness benefit. However, additional preventive services are only partially covered; excluded services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home and bathroom safety devices, and counseling.
Hearing Services See details
HealthSpring Preferred (HMO) covers annual routine hearing exams and fittings for a $10 copay and no coinsurance, and OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $399 to $1,800 and no coinsurance, excluding inner ear, outer ear, and over the ear models which are not covered.
Vision Services See details
HealthSpring Preferred (HMO) offers partially covered vision services, featuring one routine eye exam per year with a $0 to $10 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $350 annual maximum for contacts, upgrades, and one pair of eyeglasses per year.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $10 copay and no coinsurance, while other dental services are covered with no copay and no coinsurance. Covered non-Medicare dental services, including preventive cleanings, exams, and comprehensive procedures, are subject to a maximum annual plan benefit of $2,050.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and a 20% coinsurance, with prior authorization required. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services, with prior authorization and referrals required for all services. Lab services and outpatient X-rays are available with no copay, diagnostic tests and procedures range from a $0 to $95 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
HealthSpring Preferred (HMO) provides coverage for Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HealthSpring Preferred (HMO) with no coinsurance, but in practice, only some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered. Any covered services require a referral and prior authorization, and are subject to a $10 copay.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, offering Over-the-Counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. Under this plan, members can receive up to $205 every three months for OTC items and access meal benefits for qualifying chronic illnesses or medical conditions.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved