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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.
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 $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 $3500.00 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) plan features an annual drug deductible of $295 before coverage begins for certain medication tiers. For Tier 1 preferred generic drugs, you will pay no copay when utilizing preferred pharmacies or preferred mail order services, compared to a $10 monthly copay at standard pharmacies. Tier 2 generic drugs cost $4 per month at preferred locations, with no copay required for a three-month supply ordered through preferred mail delivery. For brand-name and specialty medications, the plan transitions to flat copays and coinsurance rates. Tier 3 preferred brand drugs cost a flat $47 monthly copay across all pharmacy and mail order options. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs require a 29% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers affordable medical coverage with no copay for primary care visits and a low $10 copay for specialists, physical therapy, and routine hearing exams. For hospital care, inpatient acute stays require a $265 copay for days one through five with no copay thereafter, while emergency room visits carry a $150 copay that is waived if you are admitted. Outpatient surgery and home health services are also highly accessible, featuring no coinsurance and no copays for many services. This plan also features strong supplemental benefits, including comprehensive dental care with no copay up to a $2,500 annual limit and a $350 eyewear allowance with no copay or deductible. Members can take advantage of up to 24 free one-way transportation trips per year to approved locations and an $80 quarterly allowance for over-the-counter items. Additionally, durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
HealthSpring Preferred (HMO) offers partially covered inpatient hospital services with no coinsurance and prior authorization required. Acute stays have a $265 copay for days 1 to 5 and no copay thereafter, while psychiatric stays have a $595 copay for days 1 to 3 and no copay for days 4 to 90. 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, featuring no copay for ambulatory surgical center and blood services, a $10 copay for outpatient substance abuse sessions, and copays ranging from $0 to $275 for outpatient hospital and observation services. Prior authorization is required for most outpatient services.
Partial Hospitalization See details
HealthSpring Preferred (HMO) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required to receive 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 with no copay and no coinsurance for up to 24 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 $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 limit with a $150 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, occupational, and speech therapies, mental health, psychiatric, and opioid treatment services require a $10 copay and no coinsurance. Telehealth benefits feature a $0 to $10 copay and no coinsurance, but podiatry is not covered, and only some chiropractic services are covered as routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by HealthSpring Preferred (HMO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, caregiver support, and fitness benefits. However, the plan does not cover health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety devices, or counseling services.
Hearing Services See details
HealthSpring Preferred (HMO) partially covers hearing services, offering routine exams for a $10 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 annually with no coinsurance and copays ranging from $399 to $1,800, though inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
HealthSpring Preferred (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $20 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, has no copay, no coinsurance, and no deductible, up to a $350 combined annual maximum.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $10 copay and no coinsurance, though prior authorization is required. Other preventive and comprehensive dental services are covered with no copay and no coinsurance, up to a maximum annual plan benefit of $2,500.
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 and insulin, are subject to a coinsurance of 0% 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 is required.
Medical Equipment See details
HealthSpring Preferred (HMO) covers medical equipment with no copay and a 20% coinsurance, though prior authorization is required. This benefit is partially covered because diabetic supplies are not covered, while durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts are covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under HealthSpring Preferred (HMO), with prior authorization required for all services. Diagnostic services have no coinsurance, offering lab services with no copay and diagnostic tests with a $0 to $20 copay. Radiological services feature outpatient X-rays with no copay but applicable coinsurance, diagnostic radiology with a $0 minimum copay and no coinsurance, and therapeutic radiology with a copay and a minimum 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 are not covered under the HealthSpring Preferred (HMO) plan, as intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are excluded from coverage. These services require prior authorization, a $10 copay, and no coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred (HMO) with no coinsurance, requiring a $20 copay per day for days 1 to 20, a $218 copay 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 days are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services with no copay and no coinsurance, which includes a meal benefit for qualifying medical conditions and up to $80 every three months for over-the-counter (OTC) items. Acupuncture is not covered under this plan benefit.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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