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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 South Carolina. This plan received an overall rating of 4 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 $395.00 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 $4250.00 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 $395 annual prescription drug deductible. For Tier 1 preferred generics, you will enjoy no copay when using a preferred pharmacy or preferred mail order, compared to a $10 copay for a one-month supply at standard pharmacies. Tier 2 generic medications cost a low $4 copay for a one-month supply at preferred pharmacies, while standard pharmacies charge a $20 copay. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply regardless of whether you use a preferred or standard pharmacy. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 28% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive coverage with many core services featuring no copay and no coinsurance, including primary care visits, routine preventive services, and home health care. For inpatient hospital stays, members pay a $260 daily copay for the first five days and no copay for additional days, while specialist visits and diagnostic lab tests carry low costs ranging from no copay to $10. Outpatient services and emergency care are also covered, with emergency room visits requiring a $130 copay which is waived if you are admitted to the hospital. This plan also provides valuable supplemental benefits, including dental coverage with no copay for preventive care up to a $1,550 annual limit, and a $200 yearly allowance for eyewear with no copay. Routine hearing exams require a $10 copay, and hearing aids are covered with copays starting at $399. For specialized medical needs, durable medical equipment and dialysis services require a 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no deductible.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $260 daily copay for days 1 through 5 and no copay for days 6 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance, requiring a $595 daily copay for days 1 through 3 and no copay for days 4 through 90, but additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which feature no copay. Outpatient hospital services have a copay of $0 to $275, observation services require a $275 copay per stay, and outpatient substance abuse sessions carry a $10 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the HealthSpring Preferred (HMO) plan with a $140.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $270 copay and air ambulance services with a 20% coinsurance, with prior authorization required for all transports. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
HealthSpring Preferred (HMO) emergency services are covered with a $130 copay, and urgently needed services require a $50 copay, with no coinsurance for either and copays waived if 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 $50,000 maximum plan benefit.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, and telehealth services feature a $0 to $10 copay and no coinsurance. Chiropractic and podiatry services are not covered, and prior authorization is required for most specialist and therapy services.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, such as annual physical exams, kidney disease education, fitness programs, and caregiver support, with no copay and no coinsurance. This benefit is partially covered, as it excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, additional smoking cessation, disease management, telemonitoring, remote access, bathroom safety devices, and counseling.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams and fitting evaluations for a $10 copay and no coinsurance, limited to one visit each per year. Hearing aids are also covered with no coinsurance, featuring a $399 copay for up to two OTC hearing aids yearly, and a $399 to $1,800 copay for up to two prescription hearing aids, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services under HealthSpring Preferred (HMO) are partially covered, featuring one routine eye exam per year with a $0 to $20 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $200 annual maximum, which includes contact lenses, upgrades, and one pair of eyeglasses per year.
Dental Services See details
Dental Services are covered by HealthSpring Preferred (HMO) with a $10 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other preventive and comprehensive dental services up to a $1,550 yearly maximum. Covered benefits include cleanings, exams, x-rays, restorative care, and implants, all offered with no copay and no coinsurance.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Covered Medicare Part B drugs, including chemotherapy and insulin, carry coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay and no deductible.
Dialysis Services See details
Dialysis services are covered under the HealthSpring Preferred (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and 20% coinsurance, excluding diabetic supplies which are not covered. Covered services such as durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes require prior authorization.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) diagnostic and radiological services are covered with prior authorization, featuring no coinsurance and a $0 to $95 copay for diagnostic tests, and no copay for lab services. Diagnostic radiological services have a $0 minimum copay, outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the HealthSpring Preferred (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HealthSpring Preferred (HMO) with no coinsurance and require prior authorization, though only some services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by HealthSpring Preferred (HMO) with no coinsurance, featuring a $10 daily copay for days 1 to 20, a $218 daily copay for days 21 to 60, and no copay for days 61 to 100. Prior authorization is required for these services, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers other services, providing over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, while acupuncture is not covered. The plan features a $20 quarterly OTC allowance and meal benefits for members with chronic illnesses or medical conditions requiring them to stay at home.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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