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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 2026 to people living in South 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:
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Drug Coverage
The HealthSpring Preferred (HMO) Medicare plan has an annual prescription drug deductible of $615. You can save on Tier 1 preferred generic drugs with no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generic drugs are also highly affordable, featuring a $4 copay for a one-month supply at preferred pharmacies and no copay for a three-month supply ordered through preferred mail delivery. For Tier 3 preferred brand drugs, you will pay a consistent $47 copay for a one-month supply at both standard and preferred pharmacies. Higher-tier prescriptions require coinsurance rather than flat copays, including a 50% coinsurance for Tier 4 non-preferred drugs and a 25% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust core medical coverage, featuring no copay or coinsurance for primary care visits and preventive services like annual physicals and fitness programs. For specialist visits and outpatient therapy, members pay a predictable $30 copay with no coinsurance. Inpatient hospital stays require a $320 daily copay for the first seven days, after which there is no copay for days 8 through 90. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care with no copay up to a $1,200 annual limit. Vision coverage features no copay for eyewear up to a $175 yearly allowance, while hearing benefits cover routine exams and hearing aids with set copays. Additionally, members can access home health services and an over-the-counter benefit of $65 every three months with no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $320 copay for days 1 to 7 and no copay for days 8 to 90, with unlimited additional days covered. Inpatient psychiatric stays are also covered with no coinsurance, requiring a $330 copay for days 1 to 7 and no copay for days 8 to 90, though 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, offering no copay for ambulatory surgical center and blood services. Patients will pay a $30 copay for outpatient substance abuse sessions, a $200 copay per stay for observation services, and a copay ranging from no copay to $125 for outpatient hospital services.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $55.00 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 $300 copay and air ambulance services with a 20% coinsurance, with prior authorization required. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by HealthSpring Preferred (HMO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation care is covered up to $50,000 with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, and mental health services require a $30 copay and no coinsurance. Telehealth and other health professional services range from no copay to a $30 copay with no coinsurance, whereas podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services 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. Some services require a referral, and several additional supplemental benefits, such as health education, in-home safety assessments, and nutritional therapy, are not covered.
Hearing Services See details
Hearing Services are partially covered by HealthSpring Preferred (HMO), offering annual routine exams for a $30 copay and no coinsurance, and up to two OTC hearing aids per year for a $399 copay and no coinsurance. Up to two prescription hearing aids are covered per year with copays ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), offering one routine eye exam per year with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $175 annual maximum benefit toward contact lenses or one pair of eyeglasses, lenses, and frames.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $30 copay and no coinsurance, which requires prior authorization. Other preventive and comprehensive dental services, including exams, cleanings, and implants, are covered with no copay and no coinsurance up to a maximum benefit of $1,200 every year.
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, covered Medicare Part B drugs—including chemotherapy, radiation, and insulin—subject patients to coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
HealthSpring Preferred (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is only partially covered by the plan, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization and referral requirements. Diagnostic services carry no coinsurance, offering no copay for lab work and a $0 to $95 copay for diagnostic procedures. Radiological services feature no-copay X-rays with coinsurance, diagnostic radiology with copays starting at $0, and therapeutic radiology requiring a copay and a minimum 20% coinsurance.
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 copay and no coinsurance, though prior authorization and referrals are required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and Supervised Exercise Therapy (SET) for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) 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 while a prior three-day inpatient hospital stay is not necessary, additional days beyond the standard 100 days are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $65 every three months for eligible health-related items, including nicotine replacement therapy and naloxone.
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