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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 North 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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $295.00 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 $3450.00 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 $295. For Tier 1 preferred generic drugs, members enjoy no copay when using preferred pharmacies or preferred mail order services, compared to a $10 one-month copay at standard pharmacies. Tier 2 generic drugs cost as little as $4 for a one-month supply at preferred locations, and choosing a three-month preferred mail order supply results in no copay. For brand-name and specialty medications, costs are consistent across all pharmacy and mail order types. Tier 3 preferred brand drugs require a $47 copay for a one-month supply. Tier 4 non-preferred drugs carry a 50% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers affordable coverage for routine and emergency medical needs, featuring no copay and no coinsurance for primary care visits, annual physicals, and home health services. For specialized care, members generally pay a low $20 copay for specialist visits, routine eye exams, and Medicare-covered dental care, while emergency room visits carry a $150 copay that is waived if admitted. Inpatient hospital stays require a daily copay, such as $290 for days one through five, with no copay for additional days. The plan also features valuable extra benefits, including routine dental and vision care covered with no copay up to specified annual limits, alongside an over-the-counter allowance of $45 every three months. Most diagnostic lab tests, X-rays, and home infusions are available with no copay, though certain specialized services like dialysis and durable medical equipment require a 20% coinsurance. There is no deductible for outpatient services, helping to keep out-of-pocket costs predictable for members.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required and upgrades or non-Medicare-covered stays are not covered. For acute admissions, you pay a $290 daily copay for days 1 through 5 and no copay for additional days, while psychiatric admissions require a $595 daily copay for days 1 through 3 and no copay for days 4 through 90.
Outpatient Services See details
HealthSpring Preferred (HMO) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center (ASC) and blood services, a $20 copay for outpatient substance abuse sessions, and copays ranging from $0 to $290 for outpatient hospital and observation services. Prior authorization is required for most of these outpatient services, but there is no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred (HMO) with a $175.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services under the HealthSpring Preferred (HMO) plan cover ground ambulance services with a $270 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services to health-related locations are not covered by this plan.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $65 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $150 copay and no coinsurance.
Primary Care See details
Primary care benefits under HealthSpring Preferred (HMO) offer primary care physician services with no copay and no coinsurance, while telehealth benefits range from a $0 to $20 copay with no coinsurance. Most other covered services, including specialists, mental health, and physical therapies, require a $20 copay and no coinsurance, whereas podiatry and chiropractic services are not covered.
Preventive Services See details
HealthSpring Preferred (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. This benefit is partially covered, as additional services such as a fitness benefit and caregiver support are included, but health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
HealthSpring Preferred (HMO) covers hearing exams with a $20 copay and no coinsurance, and OTC hearing aids with a $399 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $1,800, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Preferred (HMO) partially covers vision services, as other eye exam services are not covered. Routine eye exams are covered once yearly with a $0 to $20 copay and no coinsurance, while eyewear has no copay, no coinsurance, and no deductible up to a $200 annual maximum.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $20 copay and no coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum annual plan benefit of $1,850.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by HealthSpring Preferred (HMO) with no copay and no coinsurance, though prior authorization and step therapy apply. Covered Medicare Part B drugs, including chemotherapy and insulin, require 0% to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
HealthSpring Preferred (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and 20% coinsurance, though prior authorization is required. Covered items include durable medical equipment, prosthetics, and diabetic therapeutic shoes, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization required, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests carry a copay of $0 to $20 with no coinsurance, while diagnostic radiological services start at a $0 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Preferred (HMO) with no coinsurance and a $10 copay, though prior authorization is required. Some services are covered, but 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
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a copay of $20 per day for days 1 to 20, $218 per day 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
Other Services under HealthSpring Preferred (HMO) are partially covered, offering over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The plan provides up to $45 every three months for OTC items and covers meals for qualifying chronic or medical conditions.
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