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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 $163.00. 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 $6700.00 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) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order, while standard pharmacies charge a $10 monthly copay. Tier 2 generic drugs cost a low $4 copay per month at preferred pharmacies, with no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand-name drugs require a flat $47 monthly copay regardless of whether you use preferred or standard pharmacies. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance across all pharmacy options. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply across all preferred and standard pharmacy and mail order channels.
Additional Benefits
The HealthSpring Preferred Savings (HMO) plan offers robust coverage with no copay or coinsurance for primary care visits, preventive services, and home health care. For specialized medical needs, patients will encounter predictable copays, such as $45 for specialist visits, a $130 copay for emergency services, and daily copays for inpatient hospital stays. Diagnostic lab services, ambulatory surgical center procedures, and cardiac rehabilitation are also covered with no copay or coinsurance, helping to keep out-of-pocket costs low. Additional benefits include preventive and comprehensive dental care with no copay up to a $600 annual limit, alongside vision services featuring routine exams and a $200 allowance for eyewear with no copay. Hearing services are also available with affordable copays for exams and hearing aids, while home infusion and qualifying meal benefits are covered with no copay. Some services, including dialysis and durable medical equipment, require a 20% coinsurance, and prior authorizations are necessary for several key benefits.
Inpatient Hospital See details
Inpatient Hospital benefits under HealthSpring Preferred Savings (HMO) are covered with no coinsurance, though prior authorization is required. Acute stays require a $300 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $595 daily 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
Outpatient services are covered by HealthSpring Preferred Savings (HMO) with no coinsurance, featuring a copay of $0 to $425 for outpatient hospital services and $425 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay or coinsurance, while outpatient substance abuse sessions require 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 coverage for this benefit.
Ambulance and Transportation Services See details
HealthSpring Preferred Savings (HMO) covers ambulance services with a $290 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport, with prior authorization required. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
HealthSpring Preferred Savings (HMO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with a $130 copay and no coinsurance, up to a $50,000 maximum benefit limit.
Primary Care See details
HealthSpring Preferred Savings (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health visits require a $45 copay and no coinsurance. Telehealth and other healthcare professional services range from a $0 to $45 copay with no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred Savings (HMO) covers preventive services, including annual physical exams, kidney disease education, and various screenings, with no copay and no coinsurance. While fitness benefits and caregiver support are included, this benefit is only partially covered because services such as health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred Savings (HMO), featuring annual routine exams and fitting evaluations for a $25 copay and no coinsurance, and up to two OTC hearing aids per year for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $1,800 copay and no coinsurance for up to two aids per year, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred Savings (HMO), featuring one routine eye exam per year with a $0 to $50 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $200 annual maximum, which includes contact lenses, lenses, frames, and upgrades.
Dental Services See details
HealthSpring Preferred Savings (HMO) covers Medicare-covered dental services with a $45 copay and no coinsurance, subject to prior authorization. Preventive and comprehensive dental services, including cleanings, exams, and implants, are covered with no copay and no coinsurance up to a maximum plan benefit of $600 every year.
Home Infusion bundled Services See details
HealthSpring Preferred Savings (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, have no coinsurance to 20% coinsurance, while Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Preferred Savings (HMO) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
HealthSpring Preferred Savings (HMO) partially covers medical equipment with no copay and a 20% coinsurance, subject to prior authorization. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes are covered, diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
HealthSpring Preferred Savings (HMO) covers diagnostic and radiological services with prior authorization, offering diagnostic services with no coinsurance, a $0 to $20 copay for procedures, and no copay for lab services. Radiological services feature no copay for outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred Savings (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Preferred Savings (HMO) with no copay and no coinsurance, though prior authorization is required and some services are covered while cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Preferred Savings (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. Patients pay a $10 daily copay for days 1 through 20, a $218 daily copay for days 21 through 60, and no copay for days 61 through 100, though additional days beyond the Medicare limit are not covered.
Other Services See details
HealthSpring Preferred Savings (HMO) provides partial coverage for Other Services, offering a meal benefit for qualifying medical conditions with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other additional services are not covered under this benefit.
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