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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 $3550.00 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 a $295 annual prescription drug deductible. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or preferred mail-order services, whereas standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic medications cost as little as a $4 copay for a one-month supply at preferred locations, and there is no copay for a three-month supply filled through preferred mail order. For Tier 3 preferred brand drugs, the plan charges a flat $47 copay for a one-month supply across all pharmacy and mail-order options. Higher-tier medications are subject to coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 29% coinsurance for a one-month supply. Choosing preferred network pharmacies and mail-order services provides the greatest savings under this plan.
Additional Benefits
The HealthSpring Preferred (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, routine dental care, and therapy services are highly affordable, requiring only a low copayment and no coinsurance. For inpatient hospital stays, members pay a set copay for the first few days of a stay, with no coinsurance and no copay required for subsequent days. Additional highlights of the plan include vision coverage with no copay for eyewear up to a $250 annual limit, and dental benefits covering preventive services with no copay up to $1,600 yearly. Diagnostic lab and X-ray services are available with no copay, while durable medical equipment and dialysis require a 20% coinsurance. Members also benefit from meal benefits and a quarterly over-the-counter allowance with no copay and no coinsurance.
Inpatient Hospital See details
HealthSpring Preferred (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $250 copayment for days 1 to 5 of acute stays and a $595 copayment for days 1 to 3 of psychiatric stays, with no copay for subsequent days. Upgrades and non-Medicare-covered stays 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. Outpatient substance abuse sessions require a $15 copay, while outpatient hospital and observation services have copays ranging from no copay up to $270, with prior authorization required for most 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 covered benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred (HMO) covers ambulance services with prior authorization, requiring a $270 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to plan-approved or other health-related locations are 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 plan 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, therapy, psychiatric, and mental health services require a $15 copay and no coinsurance. Chiropractic care carries a $20 copay and no coinsurance, though routine chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under HealthSpring Preferred (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and various screenings. Additional preventive benefits are partially covered, offering fitness benefits and caregiver support, while excluding services such as health education, in-home safety assessments, and weight management programs.
Hearing Services See details
HealthSpring Preferred (HMO) covers routine hearing exams and fittings for a $15 copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $1,800 copay and no coinsurance—with inner ear, outer ear, and over the ear types not covered—while OTC hearing aids require a $399 copay and no coinsurance.
Vision Services See details
HealthSpring Preferred (HMO) partially covers vision services, offering one annual routine eye exam with a $0 to $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a combined maximum of $250 per year for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
HealthSpring Preferred (HMO) covers Medicare-covered dental services with a $15 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 $1,600.
Home Infusion bundled Services See details
HealthSpring Preferred (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% (no coinsurance) to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% (no coinsurance) to 20% coinsurance.
Dialysis Services See details
HealthSpring Preferred (HMO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required for these services.
Medical Equipment See details
HealthSpring Preferred (HMO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, although diabetic supplies are not covered. Prior authorization is required for these covered items.
Diagnostic and Radiological Services See details
HealthSpring Preferred (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests have no coinsurance and copays ranging from $0 to $20, lab and outpatient X-ray services have no copay, and therapeutic radiological services require a copay and 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, subject to prior authorization. While some services are covered, specific programs including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $20 for days 1 through 20, $218 for days 21 through 60, and no copay for days 61 through 100. Prior authorization is required, though a prior three-day hospital stay is not, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Preferred (HMO) partially covers Other Services, offering meal benefits and up to $40 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other additional services are not covered.
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