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HealthSpring Preferred Savings (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Preferred Savings (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Preferred Savings (HMO) in 2026, please refer to our full plan details page.
HealthSpring Preferred Savings (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 Savings (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 Savings (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 Savings (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 $174.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $6000.00 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 Savings (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail-order service, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generic drugs cost as little as a $4 copay for a one-month supply at preferred pharmacies, and you can receive a three-month supply for no copay through preferred mail order. For brand-name and specialty medications, the plan transitions to flat copays and coinsurance. Tier 3 preferred brand drugs require a $47 copay for a one-month supply across all pharmacy and mail-order options. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 33% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The HealthSpring Preferred Savings (HMO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits and preventive services. For specialized care, members pay a $45 copay with no coinsurance for specialist visits, while emergency room visits require a $130 copay. Inpatient hospital stays require a $370 daily copay for the first six days, with no copay and no coinsurance for days seven and beyond. This plan also includes valuable supplemental benefits, including preventive and comprehensive dental services with no copay up to a $500 annual limit. Routine vision exams range from no copay to a $50 copay, with a $200 yearly allowance for eyewear featuring no copay. Additionally, hearing services are covered with a $25 copay for routine exams and fixed copays for hearing aids, while home health services are provided with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by HealthSpring Preferred Savings (HMO) with no coinsurance, though prior authorization is required and upgrades or non-Medicare-covered stays are not covered. For acute stays, there is a $370 daily copay for days 1-6 and no copay for days 7 and beyond, while psychiatric stays require a $595 daily copay for days 1-3 and no copay for days 4-90.
Outpatient Services See details
HealthSpring Preferred Savings (HMO) covers outpatient services with no coinsurance, featuring a $0 to $370 copay for outpatient hospital services and a $370 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
HealthSpring Preferred Savings (HMO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred Savings (HMO) covers ground ambulance services with a $290 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
HealthSpring Preferred Savings (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 limit with a $130 copay and no coinsurance, with none of these costs counting toward the plan deductible.
Primary Care See details
HealthSpring Preferred Savings (HMO) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services require a $45 copay and no coinsurance. Telehealth services feature a $0 to $45 copay and no coinsurance, though podiatry, routine chiropractic, and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by HealthSpring Preferred Savings (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and select screenings. Additional preventive services are only partially covered, as health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred Savings (HMO), offering annual routine exams and fittings for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with copays from $399 to $1,800 and no coinsurance for up to two devices yearly, though inner ear, outer ear, and over the ear types are not covered. Up to two OTC hearing aids are also covered per year with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring Preferred Savings (HMO) offers partially covered vision services, featuring one annual routine eye exam with no copay to a $50 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing a combined maximum benefit of $200 per year for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
HealthSpring Preferred Savings (HMO) covers Medicare-covered dental services with a $45 copay and no coinsurance. Other preventive and comprehensive dental services, including exams, cleanings, and restorative care, are covered with no copay and no coinsurance up to a maximum annual benefit of $500.
Home Infusion bundled Services See details
HealthSpring Preferred Savings (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, insulin, and other drugs feature coinsurance ranging from no coinsurance to 20%, with insulin requiring a $35 copay and other Part B drugs requiring no copay.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Preferred Savings (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
HealthSpring Preferred Savings (HMO) covers medical equipment with no copays and a 20% coinsurance, subject to prior authorization. This benefit is partially covered, as durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred Savings (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures have no coinsurance and a $0 to $20 copay, lab services, outpatient X-rays, and diagnostic radiology have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred Savings (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Preferred Savings (HMO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization required, though only some services are covered in practice. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred Savings (HMO) partially covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring a daily copay of $10 for days 1 to 20, $218 for days 21 to 60, and no copay for days 61 to 100. Prior authorization is required, and while a prior 3-day hospital stay is not needed, additional days beyond the standard 100 days are not covered.
Other Services See details
HealthSpring Preferred Savings (HMO) partially covers Other Services, offering a limited-duration meal benefit for qualifying medical conditions with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other supplemental benefits under this category are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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