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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 $14.00. 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 $3250.00 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) plan features a 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. Tier 2 generic drugs are also highly affordable, starting at a $4 copay for a one-month supply at preferred pharmacies and no copay for a three-month supply filled via preferred mail order. Tier 3 preferred brand drugs require a flat $47 copay for a one-month supply at both standard and preferred pharmacies. For higher-tier medications, you will pay a coinsurance percentage, which includes 50% coinsurance for Tier 4 non-preferred drugs and 30% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The HealthSpring Preferred Plus (HMO) plan offers robust medical coverage with no copay and no coinsurance for primary care doctor visits, home health services, and covered preventive care. For hospital stays, members pay no coinsurance, though inpatient acute care requires a $280 daily copay for the first five days and emergency room visits carry a $150 copay. Specialist visits, physical therapy, and outpatient substance abuse sessions are also highly affordable with a $15 copay and no coinsurance. Supplemental benefits are a key highlight of this plan, featuring preventive and comprehensive dental care with no copay up to a generous $2,500 annual limit. Eyewear is covered with no copay up to a $250 yearly maximum, while routine hearing exams and fittings require a $15 copay. Additionally, members can access select over-the-counter items and a meal benefit with no copay or coinsurance, helping to keep out-of-pocket health costs low.
Inpatient Hospital See details
HealthSpring Preferred Plus (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, though prior authorization is required. Acute stays require a $280 copay per day for days 1 to 5 (with no copay for additional unlimited days), while psychiatric stays require a $595 copay per day for days 1 to 3 (with no copay for days 4 to 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
HealthSpring Preferred Plus (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services for no copay. Outpatient hospital services have a copay of $0 to $285 (with a $285 copay per stay for observation services), while outpatient substance abuse sessions require a $15 copay.
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 for this service.
Ambulance and Transportation Services See details
HealthSpring Preferred Plus (HMO) covers ambulance services with prior authorization, requiring a $270 copay for ground transport and a 20% coinsurance for air transport. Transportation services are not covered under this plan.
Emergency Services See details
Emergency services are covered by HealthSpring Preferred Plus (HMO) 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) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and mental health services require a $15 copay and no coinsurance. Telehealth and other health professional services feature copays ranging from $0 to $15 with no coinsurance, though chiropractic and podiatry services are not covered.
Preventive Services See details
HealthSpring Preferred Plus (HMO) offers partial coverage for preventive services with no copay and no coinsurance for covered benefits like annual physical exams, fitness benefits, and kidney disease education. However, many supplemental services are not covered under this plan, including health education, in-home safety assessments, personal emergency response systems, and nutritional or weight management programs.
Hearing Services See details
HealthSpring Preferred Plus (HMO) covers annual routine hearing exams and fittings for a $15 copay and no coinsurance. Hearing aids are partially covered, offering up to two OTC hearing aids per year for a $399 copay and no coinsurance, and up to two prescription hearing aids per year for a $399 to $1,800 copay and no coinsurance, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
HealthSpring Preferred Plus (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $15 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $250 annual combined maximum for contacts, upgrades, and one pair of eyeglasses.
Dental Services See details
HealthSpring Preferred Plus (HMO) covers Medicare-covered dental services with a $15.00 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a maximum benefit of $2,500 every year.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSpring Preferred Plus (HMO) with no copay, while associated Medicare Part B drugs, including chemotherapy and insulin, require no coinsurance up to 20% coinsurance. Part B insulin drugs also carry a $35 copay, and prior authorization and step therapy may apply.
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 20% coinsurance, though prior authorization is required. This benefit is partially covered, as diabetic therapeutic shoes and inserts are covered, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Preferred Plus (HMO) with prior authorization required, offering no copay or coinsurance for lab services. Diagnostic tests require a copay of $0 to $95 with no coinsurance, while outpatient X-rays have no copay but require coinsurance, and therapeutic services require both a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by HealthSpring Preferred Plus (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 Plus (HMO) with no coinsurance, though prior authorization is required. While some services are covered, 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 but no prior three-day inpatient hospital stay. For each admission, you will pay a daily copay of $20 for days 1 to 20, a daily copay of $218 for days 21 to 60, and no copay for days 61 to 100, though 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 provides over-the-counter (OTC) items and a meal benefit with no copay and no coinsurance. Acupuncture is not covered under this plan.
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