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 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 $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:
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 an annual drug deductible of $295. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service, compared to a $10 copay for a one-month supply at standard pharmacies. Tier 2 generic medications cost as low as a $4 copay for a one-month supply at preferred locations, while standard pharmacies charge a $20 copay. Tier 3 preferred brand drugs require a $47 copay for a one-month supply regardless of whether you use a preferred or standard pharmacy. For higher-tier medications, Tier 4 non-preferred drugs have a 50% coinsurance, and Tier 5 specialty drugs require a 29% coinsurance for a one-month supply.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits, while specialist visits and therapy sessions require a low $15 copay. For hospital stays, inpatient acute care incurs a $195 daily copay for the first five days, after which there is no copay, and outpatient surgical services are available with no copay. Emergency room visits carry a $150 copay, which is waived if you are admitted, and the plan provides worldwide emergency coverage up to a $50,000 maximum. This plan also features strong supplemental benefits, including preventive and comprehensive dental care with no copay up to a $1,650 annual limit, and routine eyewear covered up to $250 annually with no copay. Routine hearing exams carry a $15 copay, while hearing aids are available with copays starting at $399. Additionally, members benefit from an $85 quarterly over-the-counter allowance and no copay for home health services, though durable medical equipment requires a 20% coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) covers inpatient hospital services with no coinsurance, requiring prior authorization. Acute care has a $195 daily copay for days 1-5 (no copay for days 6-90 and unlimited additional days), while psychiatric care requires a $595 daily copay for days 1-3 (no copay for days 4-90); non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred (HMO) outpatient services feature no coinsurance, with outpatient hospital copays ranging from no copay up to $250 and ambulatory surgical center services requiring no copay. Observation services carry a $195 copay per stay, outpatient substance abuse sessions require a $15 copay, and blood services are covered with no copay or 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 to receive this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance services with prior authorization, requiring a $265 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Although some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
HealthSpring Preferred (HMO) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $65 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $150 copay and no coinsurance per service, up to a maximum plan benefit of $50,000.
Primary Care See details
HealthSpring Preferred (HMO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health visits require a $15 copay and no coinsurance. Podiatry is not covered, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under HealthSpring Preferred (HMO) with no copay and no coinsurance for covered services like annual physicals, caregiver support, kidney disease education, and fitness benefits. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred (HMO), offering annual routine exams and fittings for a $15 copay and no coinsurance. OTC hearing aids are covered for a $399 copay and no coinsurance, while prescription hearing aids are partially covered with copays ranging from $399 to $1,800 and no coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
HealthSpring Preferred (HMO) offers partially covered vision services, as other eye exam services are not covered. Routine eye exams carry a $0 to $20 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and no deductible up to a $250 annual maximum.
Dental Services See details
Dental services are covered by HealthSpring Preferred (HMO), featuring a $15 copay and no coinsurance for Medicare-covered dental services. Other preventive and comprehensive dental services, including cleanings, fillings, and implants, are covered with no copay and no coinsurance up to a maximum annual benefit of $1,650.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred (HMO) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, insulin, and other drugs carry a coinsurance ranging from no coinsurance to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Preferred (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered under HealthSpring Preferred (HMO), offering covered services with no copay and a 20% coinsurance, subject to prior authorization. This coverage includes durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts, though diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization, offering no coinsurance for diagnostic services and no copays for lab services, diagnostic radiology, and outpatient X-rays. Diagnostic procedures and tests have a copay of up to $20, while therapeutic radiological services require 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 none of the sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation—are covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copayment of $20 for days 1 through 20, $218 for days 21 through 60, and no copayment for days 61 through 100. Prior authorization is required, 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 with an $85 quarterly limit and meal benefits with no copay and no coinsurance, while acupuncture is not covered.
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