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 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:
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) medicare plan features a $395 prescription drug deductible and offers significant savings on generic medications. You will pay no copay for Tier 1 preferred generic drugs filled at preferred pharmacies or through preferred mail order, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic drugs start at a $4 copay for a one-month supply at preferred locations, with no copay required for a three-month preferred mail order. For brand-name and specialty medications, Tier 3 preferred brand drugs carry a flat $47 copay for a one-month supply across all pharmacy and mail-order options. Higher-tier prescriptions require coinsurance instead of a flat copay, including a 50% coinsurance for Tier 4 non-preferred drugs and a 28% coinsurance for a one-month supply of Tier 5 specialty drugs.
Additional Benefits
HealthSpring Preferred (HMO) offers comprehensive coverage with no copay and no coinsurance for primary care visits, home health services, and routine physicals. Specialty care, mental health services, and Medicare-covered dental visits require a low $10 copay, while inpatient hospital stays incur daily copays with no coinsurance. Outpatient hospital services and emergency care are also covered, with copays ranging up to $260. This plan features strong supplemental benefits, including no copay for preventive dental care up to a $1,750 annual limit and a $200 allowance for eyewear. Members pay a 20% coinsurance with no copay for dialysis, medical equipment, and therapeutic radiology services. Additionally, the plan provides convenient extras with no copay, including up to 20 one-way transportation trips and a $40 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient hospital stays with no coinsurance, though prior authorization is required. Acute stays require a $250 daily copay for days 1 to 4 and no copay thereafter, while psychiatric stays require a $595 daily copay for days 1 to 3 and no copay thereafter; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $260 copay and observation services with a $260 copay per stay. Ambulatory surgical center and outpatient blood services carry no copay, while outpatient substance abuse sessions require a $10 copay, with prior authorization required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) 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 $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or coinsurance for up to 20 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services 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 services are covered up to a $50,000 maximum with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, while specialists, mental health, therapies, and opioid treatment services require a $10 copay and no coinsurance. Telehealth and other professional services range from a $0 to $10 copay with no coinsurance, though podiatry is not covered and chiropractic services exclude routine and other care.
Preventive Services See details
Preventive services under HealthSpring Preferred (HMO) are partially covered with no copay and no coinsurance for annual physical exams, fitness benefits, caregiver support, and kidney disease education. However, several supplemental services are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems, and nutritional or dietary benefits.
Hearing Services See details
HealthSpring Preferred (HMO) provides hearing services with a $10 copay and no coinsurance for yearly routine exams and fitting evaluations. Hearing aids are partially covered with no coinsurance, requiring a $399 copay for OTC devices and a $399 to $1,800 copay for up to two prescription aids per year, though inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), featuring routine eye exams with a $0 to $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 annual limit, which includes contact lenses, upgrades, and one annual pair of eyeglasses.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $10 copay and no coinsurance, which require prior authorization. Other preventive and comprehensive dental services, including exams, cleanings, implants, and orthodontics, are covered with no copay and no coinsurance up to a maximum benefit of $1,750 every year.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, require coinsurance ranging from no coinsurance to 20%, with insulin also carrying a $35 copay.
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
Medical equipment is partially covered by HealthSpring Preferred (HMO) with no copays and a 20% coinsurance, and prior authorization is required for these services. While durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HealthSpring Preferred (HMO), with prior authorization required for all services. Lab services and outpatient X-rays feature no copay, diagnostic tests and procedures have a copay ranging from $0 to $95 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services under HealthSpring Preferred (HMO) require prior authorization and feature no coinsurance, although standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers skilled nursing facility (SNF) care with no coinsurance, requiring 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. This benefit is partially covered because prior authorization is required and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
Other Services are partially covered by HealthSpring Preferred (HMO), which offers 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 $40 every three months for health-related items, and the meal benefit is available to support members recovering at home from chronic 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