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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 $11.00. 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, 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 are also highly affordable, starting at a $4 copay for a one-month supply at preferred pharmacies and offering no copay for a three-month supply through preferred mail order. For Tier 3 preferred brand drugs, the plan has a flat $47 copay for a one-month supply regardless of whether you use preferred or standard pharmacies. Higher-tier medications require coinsurance, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance for a one-month supply. This cost-sharing structure helps lower out-of-pocket prescription costs, especially when utilizing preferred network providers.
Additional Benefits
The HealthSpring Preferred Plus (HMO) plan offers affordable health coverage with no copay for primary care visits and a $15 copay for specialist care. For emergencies, members pay a $150 copay, while inpatient hospital stays require a $265 daily copay for the first five days with no copay for subsequent days. Outpatient hospital services and ambulatory surgeries feature no coinsurance and low to no copays. Valuable supplemental benefits are also included, featuring preventive and comprehensive dental services with no copay up to a $2,300 annual maximum. Vision care includes routine exams and up to $200 annually for eyewear with no copay, alongside covered hearing exams and hearing aid benefits. Eligible members also receive a quarterly over-the-counter allowance and home-delivered meals with no copay.
Inpatient Hospital See details
Inpatient hospital services are partially covered by HealthSpring Preferred Plus (HMO) with no coinsurance, although prior authorization is required. Medicare-covered acute stays require a $265 daily copay for days 1 to 5 with no copay thereafter, while psychiatric stays cost a $595 daily copay for days 1 to 3 with no copay for days 4 to 90; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred Plus (HMO) covers outpatient hospital services with no coinsurance and copays ranging from no copay up to $285, alongside observation services for a $285 copay per stay and no coinsurance. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $15 copay per session with no coinsurance.
Partial Hospitalization See details
HealthSpring Preferred Plus (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
Ambulance and transportation services under HealthSpring Preferred Plus (HMO) cover ground ambulance services with a $270 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for all ambulance services, while transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services under the HealthSpring Preferred Plus (HMO) are covered 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 maximum 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 visits, therapy, and mental health services require a $15 copay and no coinsurance. Additional telehealth services range from a $0 to $15 copay with no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
HealthSpring Preferred Plus (HMO) covers preventive services, including annual physical exams, kidney disease education, and screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered to include fitness and caregiver support, but health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling services are not covered.
Hearing Services See details
HealthSpring Preferred Plus (HMO) hearing services are partially covered, featuring one annual routine exam and fitting for a $15 copay and no coinsurance. Up to two prescription hearing aids per year are covered with a copay ranging from $399 to $1,800 and no coinsurance (excluding inner ear, outer ear, and over the ear models), while up to two OTC hearing aids are covered annually with a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred Plus (HMO) since other eye exam services are not covered, though routine exams are covered with a $0 to $15 copay, no coinsurance, and no deductible. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $200 annual maximum for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are covered by HealthSpring Preferred Plus (HMO), including Medicare-covered dental services for a $15 copay and no coinsurance, which require prior authorization. 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 the HealthSpring Preferred Plus (HMO) plan with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and 0% to 20% coinsurance, while covered Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the HealthSpring Preferred Plus (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by HealthSpring Preferred Plus (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, and diabetic therapeutic shoes. This benefit is partially covered, as diabetic supplies are not covered, and prior authorization is required for these services.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred Plus (HMO), though prior authorization is required. Diagnostic tests and procedures have no coinsurance and a $0 to $95 copay, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
HealthSpring Preferred Plus (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSpring Preferred Plus (HMO) with no coinsurance and prior authorization required, although in practice only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered, with each requiring 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 but no prior three-day hospital stay. For each stay, you will pay a $20 copay per day for days 1–20, a $218 copay per day for days 21–60, and no copay for days 61–100, while additional days beyond the Medicare-covered limit 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 $20 every three months for health-related items, and the meal benefit is available to eligible members with chronic or medical conditions.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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