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 2026 to people living in Central 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 a $615.00 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 $6750.00 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 $615 annual drug deductible. For Tier 1 preferred generic drugs, you pay no copay when using a preferred pharmacy or preferred mail order service, compared to a $10 copay at standard pharmacies for a one-month supply. Tier 2 generic drugs cost a $4 copay for a one-month supply at preferred pharmacies and a $20 copay at standard pharmacies. Tier 3 preferred brand drugs require a $47 copay for a one-month supply across all pharmacy and mail order options. For higher-tier medications, members pay a 50% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs. A three-month supply of Tier 2 generic drugs is also available with no copay through preferred mail order.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers affordable healthcare coverage with no copay for primary care physician visits, key preventive services, and home health care. For inpatient hospital stays, members pay a predictable $350 daily copay for the first six days and no copay for days seven through 90. Specialist office visits, routine hearing exams, and Medicare-covered dental services are available with a low $30 copay and no coinsurance. This plan provides robust supplemental coverage, including routine preventive and comprehensive dental care with no copay up to a $1,600 annual limit, alongside eyewear coverage with no copay up to $200 yearly. Diagnostic services like lab tests and X-rays also feature no copay, while dialysis, durable medical equipment, and therapeutic radiology require a 20% coinsurance. Emergency room visits are covered with a $130 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $350 daily copay for days 1 to 6 and no copay for days 7 to 90. This benefit is partially covered as 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 copays for ambulatory surgical center and blood services. Outpatient hospital services have a copay ranging from $0 to $200, observation services require a $200 copay per stay, and outpatient substance abuse sessions carry a $30 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by HealthSpring Preferred (HMO) with a $100 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $290 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required for both. 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 up to a $50,000 maximum with a $130 copay and no coinsurance per service.
Primary Care See details
Primary care services under HealthSpring Preferred (HMO) feature no copay and no coinsurance for primary care physician visits, while specialist visits, therapy, and mental health services require a $30 copay and no coinsurance. Telehealth and other healthcare professional services have a $0 to $30 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers key preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Although many supplemental services like health education, weight management, and in-home safety assessments are not covered, a physical and memory fitness benefit is included with no copay and no coinsurance.
Hearing Services See details
HealthSpring Preferred (HMO) covers hearing services, featuring a $30 copay and no coinsurance for annual routine hearing exams and fittings, which require a referral. Prescription hearing aids are partially covered with copays ranging from $399 to $1,800 and no coinsurance for up to two devices yearly, though inner ear, outer ear, and over the ear models are not covered. Up to two OTC hearing aids are also covered annually with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring Preferred (HMO) vision services are partially covered, providing one routine eye exam per year with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear has no copay, no coinsurance, and no deductible, offering up to a $200 annual combined maximum for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $30 copay and no coinsurance, subject to prior authorization. Other dental services, including preventive and comprehensive care like cleanings, x-rays, and implants, are covered with no copay and no coinsurance up to a maximum annual benefit of $1,600.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance with no deductible.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this covered benefit.
Medical Equipment See details
Medical Equipment is partially covered by HealthSpring Preferred (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes, all of which require prior authorization. Diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred (HMO), requiring prior authorization and referrals for care. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $95 copay for diagnostic procedures, while radiological services offer no copay for outpatient X-rays and diagnostic radiology alongside a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
HealthSpring Preferred (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred (HMO) partially covers cardiac rehabilitation services with no coinsurance, but requires referrals and prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring a daily copayment of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not required for admission, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) offers partial coverage for other services, featuring a meal benefit for chronic illnesses or qualifying medical conditions with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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