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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 $120.00. 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 $6400.00 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 coverage begins immediately. For Tier 1 preferred generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service. Tier 2 generics are also highly affordable, costing as little as a $4 copay for a one-month supply at preferred locations, with no copay required for a three-month supply through preferred mail order. Brand name and specialty medications under this plan require copayments or coinsurance depending on the drug tier. Tier 3 preferred brands have a flat $47 copay for a one-month supply across all pharmacy and mail-order options. Higher tiers, such as Tier 4 non-preferred drugs and Tier 5 specialty drugs, require a 50% and 33% coinsurance respectively.
Additional Benefits
The HealthSpring Preferred Savings (HMO) plan offers robust coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Specialist visits, physical therapy, and Medicare-certified dental services require a $45 copay, while emergency room visits have a $130 copay that is waived if you are admitted. For hospital stays, inpatient acute care requires a $425 daily copay for the first six days, after which there is no copay, and outpatient hospital services range from no copay up to a $425 copay. This plan also includes key supplemental benefits, featuring routine dental care with no copay up to a $500 annual limit and routine vision exams with a $0 to $50 copay alongside a $200 annual eyewear allowance. Hearing care is covered with a $25 copay for routine exams and copays starting at $399 for hearing aids. Additionally, diagnostic labs and home infusion services feature no copay, while durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
HealthSpring Preferred Savings (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $425 daily copay for days 1 to 6 of acute stays (no copay for days 7 to 90) and a $595 daily copay for days 1 to 3 of psychiatric stays (no copay for days 4 to 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred Savings (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services at no copay. Outpatient hospital services require a copay of $0 to $425, observation services have a $425 copay per stay, and individual or group outpatient substance abuse sessions carry a $45 copay.
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 receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by HealthSpring Preferred Savings (HMO), with ground ambulance services requiring a $290 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay, both requiring prior authorization. While some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Emergency services are covered by HealthSpring Preferred Savings (HMO) with a $130 copay and no coinsurance, with the copay 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 maximum with a $130 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred Savings (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and mental health services require a $45 copay and no coinsurance. Telehealth benefits are available with a $0 to $45 copay and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by HealthSpring Preferred Savings (HMO) with no copay and no coinsurance for annual physicals, kidney disease education, and routine screenings. Additional preventive benefits are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day services, nutritional benefits, palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, home safety devices, and counseling.
Hearing Services See details
Hearing Services are covered by HealthSpring Preferred Savings (HMO) with a $25 copay and no coinsurance for annual routine exams, and a $399 copay and no coinsurance for up to two OTC hearing aids per year. Prescription hearing aids are partially covered with no coinsurance and copays between $399 and $1,800 for up to two devices yearly, though inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
HealthSpring Preferred Savings (HMO) partially covers vision services, as other eye exam services are not covered. Covered routine eye exams have no deductible, a $0 to $50 copay, and no coinsurance, while eyewear is covered with no deductible, no copay, and no coinsurance up to a $200 annual limit.
Dental Services See details
HealthSpring Preferred Savings (HMO) covers Medicare-certified dental services with a $45 copay and no coinsurance. Other preventive and comprehensive dental services, including cleanings, exams, and implants, are covered with no copay and no coinsurance up to a maximum benefit of $500 every year.
Home Infusion bundled Services See details
HealthSpring Preferred Savings (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B chemotherapy and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and ranges from no coinsurance to 20% coinsurance.
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
Medical equipment is partially covered by HealthSpring Preferred Savings (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Prior authorization is required for these benefits, and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred Savings (HMO) with prior authorization, featuring no coinsurance and a $0 to $20 copay for diagnostic tests and labs. Radiological services feature no copay for X-rays and diagnostic radiology, though 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
Cardiac Rehabilitation Services are covered by HealthSpring Preferred Savings (HMO) with no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation (with a $50 copay), pulmonary rehabilitation (with a $35 copay), and supervised exercise therapy for peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred Savings (HMO) covers Skilled Nursing Facility (SNF) services 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 additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
HealthSpring Preferred Savings (HMO) partially covers Other Services, offering a meal benefit for qualifying chronic or medical conditions with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other additional services are not covered under this plan.
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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