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HealthSpring Preferred Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Preferred Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Preferred Plus (HMO) in 2026, please refer to our full plan details page.
HealthSpring Preferred Plus (HMO) is a HMO plan offered by Health Care Service Corporation available for enrollment in 2026 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 Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $13.00. 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 $200.00 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 $3200.00 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 Plus (HMO) prescription drug plan features an annual drug deductible of $200. For Tier 1 preferred generic drugs, members pay no copay when using preferred pharmacies or preferred mail-order services. Tier 2 generic drugs cost as low as a $4 copay for a one-month supply at preferred pharmacies, and there is no copay for a three-month supply filled through preferred mail order. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at both standard and preferred pharmacies. For higher-tier medications, the plan charges a 50% coinsurance for Tier 4 non-preferred drugs and a 30% coinsurance for Tier 5 specialty drugs. Utilizing preferred network pharmacies and mail-order options helps maximize savings on your prescription medication costs.
Additional Benefits
The HealthSpring Preferred Plus (HMO) plan offers comprehensive healthcare coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. Inpatient hospital stays require a $295 copay for days one through five and no copay for subsequent days, while specialist visits and Medicare-covered dental services carry a low $15 copay. Emergency room visits feature a $150 copay, which is waived if you are admitted, while urgent care services require a $65 copay. For specialized care, there is a 20% coinsurance for dialysis services, durable medical equipment, and certain Medicare Part B drugs. Vision and dental benefits are highly accessible, featuring no copay for eyewear up to a $225 annual limit and no copay for preventive and comprehensive dental services up to a $2,300 yearly maximum. Additionally, members receive helpful extras like a $30 quarterly allowance for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
HealthSpring Preferred Plus (HMO) covers inpatient acute hospital stays with no coinsurance, requiring a $295 copayment for days 1 to 5 and no copayment for days 6 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric stays are also covered with no coinsurance, carrying a $595 copayment for days 1 to 3 and no copayment for days 4 to 90, but additional psychiatric days and non-Medicare-covered stays are excluded.
Outpatient Services See details
HealthSpring Preferred Plus (HMO) covers outpatient services with no coinsurance, featuring a $0 to $285 copay for outpatient hospital services and a $285 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 services require a $15 copay per session and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred Plus (HMO) with a $175.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
HealthSpring Preferred Plus (HMO) covers ground ambulance services with a $270.00 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
HealthSpring Preferred Plus (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, and worldwide emergency, urgent, and transportation services are covered up to a $50,000 limit with a $150 copay and no coinsurance.
Primary Care See details
HealthSpring Preferred Plus (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, and opioid treatment services require a $15 copay and no coinsurance. Chiropractic and podiatry services are not covered, and telehealth or other healthcare professional services range from no copay to a $15 copay with no coinsurance.
Preventive Services See details
Preventive services under HealthSpring Preferred Plus (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. While fitness benefits and caregiver support are covered, other additional services such as health education, weight management programs, and personal emergency response systems are not covered.
Hearing Services See details
HealthSpring Preferred Plus (HMO) covers hearing exams for a $15 copay and no coinsurance, and OTC hearing aids for a $399 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $399 to $1,800 and no coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Preferred Plus (HMO) provides partially covered vision services, featuring routine eye exams with a $0 to $15 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $225 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are covered under the HealthSpring Preferred Plus (HMO) plan, which offers Medicare-covered dental care for a $15 copay and no coinsurance. Other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum annual benefit of $2,300.
Home Infusion bundled Services See details
Home infusion bundled services are covered under HealthSpring Preferred Plus (HMO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
HealthSpring Preferred Plus (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Preferred Plus (HMO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and a 20% coinsurance for therapeutic shoes and inserts, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred Plus (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $95, while lab services and outpatient X-rays feature no copays. Diagnostic radiological services start at a $0 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are fully covered under the HealthSpring Preferred Plus (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under HealthSpring Preferred Plus (HMO) with no coinsurance and prior authorization required, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $10 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by HealthSpring Preferred Plus (HMO) with no coinsurance, requiring prior authorization and a daily copay of $20 for days 1 through 20 and $218 for days 21 through 60, with no copay for days 61 through 100. A prior three-day hospital stay is not required for admission, but additional stay days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other services are partially covered by HealthSpring Preferred Plus (HMO), which offers over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance, while acupuncture is not covered. The OTC benefit provides up to $30 every three months for approved items, and the meal benefit is available at no cost for members with qualifying chronic or medical conditions.
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