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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 an annual drug deductible of $395. For Tier 1 preferred generic drugs, members enjoy no copay when using a preferred pharmacy or preferred mail-order service, while standard options require a $10 copay for a one-month supply. Tier 2 generic prescriptions are also highly affordable, costing a $4 copay for a one-month fill at preferred pharmacies compared to $20 at standard pharmacies. Tier 3 preferred brand drugs carry a $47 copay for a one-month supply across all pharmacy and mail-order options. For higher-tier medications, members pay a coinsurance of 50% for Tier 4 non-preferred drugs and 28% for Tier 5 specialty drugs. Choosing preferred network pharmacies and mail-order services offers the greatest savings on your prescription drug costs with this plan.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers robust medical coverage with predictable out-of-pocket costs, including no copay for primary care physician visits and routine preventive services. For inpatient acute hospital stays, members pay a $255 daily copay for days one through six and no copay for additional days. Emergency room visits require a $130 copay, which is waived if you are admitted, while specialist visits require a $25 copay with no coinsurance. This plan also features valuable everyday health benefits, including dental coverage with no copay up to a $1,300 annual limit and eyewear coverage with no copay up to $225 annually. Additionally, members can access up to 24 one-way routine transportation trips to plan-approved locations and an over-the-counter item allowance of $35 every three months with no copay. Hearing exams and prescription hearing aids are also covered with set copays and no coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute stays with no coinsurance, requiring a $255 daily copay for days 1 to 6 and no copay for days 7 to 90 with unlimited additional days, excluding upgrades and non-Medicare-covered stays. Inpatient psychiatric stays are also covered with no coinsurance, requiring a $595 daily copay for days 1 to 3 and no copay for days 4 to 90, though prior authorization is required and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient Services under HealthSpring Preferred (HMO) are covered with no coinsurance, featuring a $0 to $285 copay for outpatient hospital services and a $285 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay, while outpatient substance abuse individual and group sessions require a $25 copay.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ground ambulance services with a $270 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though trips to any health-related location are 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) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $25 copay and no coinsurance. Mental health and psychiatric services have a $30 copay with no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Although fitness benefits and caregiver support are covered, several other additional preventive services, such as health education, personal emergency response systems, and nutritional therapy, are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) provides partially covered hearing services, including annual routine exams and fitting evaluations for a $25 copay and no coinsurance. Prescription hearing aids are covered for up to two devices per year with a copay ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are also covered for a $399 copay and no coinsurance for up to two devices annually.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred (HMO), which excludes other eye exam services but covers one annual routine eye exam with a $0 to $30 copay, no deductible, and no coinsurance. Eyewear is also covered with no copay, no deductible, and no coinsurance, providing up to a $225 annual maximum benefit for contacts, eyeglasses, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare dental services with a $25 copay and no coinsurance, subject to prior authorization. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum annual benefit of $1,300.
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 chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance with no copay, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
Medical equipment is partially covered by HealthSpring Preferred (HMO) with no copay and 20% coinsurance, requiring prior authorization for durable medical equipment, prosthetics, and diabetic therapeutic shoes. Diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests carry a copay of $0 to $95 with no coinsurance, while therapeutic radiological services require 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
Cardiac Rehabilitation Services are not covered under the HealthSpring Preferred (HMO) plan, as all key sub-services, including intensive cardiac, pulmonary, and supervised exercise therapy, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred (HMO) 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. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) covers over-the-counter (OTC) items up to $35 every three months and a limited-duration meal benefit with no copay and no coinsurance. Acupuncture and other additional services are not covered under this benefit.
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