A non-government entity
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 $3300.00 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:
Sign up for HealthSpring Preferred Plus (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The HealthSpring Preferred Plus (HMO) plan features a $200 annual drug deductible. You can save money on prescription drugs by using preferred pharmacies or preferred mail order services, which offer no copay for Tier 1 preferred generic drugs. For Tier 2 generic drugs, copays are as low as $4 for a one-month supply, and you pay no copay for a three-month supply when using preferred mail order. Tier 3 preferred brand drugs carry a consistent copay of $47 for a one-month supply across all pharmacy and mail order options. If you require Tier 4 non-preferred drugs or Tier 5 specialty drugs, you will pay a coinsurance of 50% and 30% respectively.
Additional Benefits
The HealthSpring Preferred Plus (HMO) plan offers comprehensive medical coverage, featuring no copay for primary care physician visits and annual physical exams, while specialist visits require a $15 copay. Inpatient acute hospital stays require a $270 daily copay for days one through five, followed by no copay for additional days. Emergency room visits carry a $150 copay, which is waived if you are admitted to the hospital within 24 hours. For supplemental care, the plan provides dental services with no copay up to a $2,300 annual limit, alongside eyewear coverage with no copay up to a $200 yearly maximum. Members also benefit from a $30 quarterly over-the-counter allowance with no copay and fully covered home health services. While many services feature no coinsurance, certain benefits like medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
HealthSpring Preferred Plus (HMO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $270 copay per day for days 1 to 5 of acute stays and a $595 copay per day for days 1 to 3 of psychiatric stays, followed by no copay. While additional acute stay days are unlimited, 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, though prior authorization is required for most treatments. Patients will pay no copay for ambulatory surgical center and blood services, a $15 copay for outpatient substance abuse sessions, and a $0 to $285 copay for outpatient hospital services, which includes a $285 copay per stay for observation services.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSpring Preferred Plus (HMO) with a $175.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by HealthSpring Preferred Plus (HMO), with prior authorization required for all ambulance services. Ground ambulance services require a $270 copay, air ambulance services require a 20% coinsurance, and transportation services to plan-approved or any health-related locations are not covered.
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) covers primary care physician services with no copay and no coinsurance, while specialists, therapy, and mental health services require a $15 copay and no coinsurance. Podiatry services are not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
HealthSpring Preferred Plus (HMO) covers preventive services like annual physical exams and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness and caregiver support; however, sub-services including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are covered by HealthSpring Preferred Plus (HMO), featuring a $15 copay and no coinsurance or deductible for annual routine exams and fittings. Prescription hearing aids are partially covered up to two per year with no coinsurance and copays ranging from $399 to $1,800, excluding inner ear, outer ear, and over the ear models, while OTC hearing aids are covered with a $399 copay and no coinsurance.
Vision Services See details
Vision services are partially covered by HealthSpring Preferred Plus (HMO), which features routine eye exams with a $0 to $15 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 for contacts, eyeglasses, and upgrades.
Dental Services See details
HealthSpring Preferred Plus (HMO) covers Medicare-covered dental services with a $15 copay and no coinsurance, subject to prior authorization. Other preventive and comprehensive dental services, including cleanings, exams, and implants, 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 by HealthSpring Preferred Plus (HMO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by HealthSpring Preferred Plus (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
HealthSpring Preferred Plus (HMO) partially covers medical equipment with no copay and a 20% coinsurance, with prior authorization required. Under this benefit, durable medical equipment, prosthetics, and diabetic therapeutic shoes are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
HealthSpring Preferred Plus (HMO) covers diagnostic and radiological services with no coinsurance for diagnostic tests and no copays for lab services and outpatient X-rays. Diagnostic procedures have a copay of $0 to $95, while therapeutic radiological services require a minimum 20% coinsurance, and prior authorization is required.
Home Health Services See details
Home Health Services are 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 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
HealthSpring Preferred Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring a $20 daily copay for days 1-20, a $218 daily copay for days 21-60, and no copay for days 61-100. Prior authorization is required, and additional days beyond Medicare-covered services are not covered.
Other Services See details
Other Services are partially covered by HealthSpring Preferred Plus (HMO), offering over-the-counter (OTC) items and meal benefits with no copay and no coinsurance, though acupuncture is not covered. The OTC benefit provides a maximum allowance of $30 every three months for approved health products.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved