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HealthSpring Premier (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSpring Premier (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSpring Premier (HMO-POS) in 2026, please refer to our full plan details page.
HealthSpring Premier (HMO-POS) is a HMO-POS plan offered by Health Care Service Corporation available for enrollment in 2026 to people living in Richmond. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that HealthSpring Premier (HMO-POS) 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 Premier (HMO-POS).
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 Premier (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.00. 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 $250.00 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 $3850.00 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 Premier (HMO-POS) plan features an annual drug deductible of $250. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or preferred mail order services, while standard pharmacies and mail order options require a $10 monthly copay. Tier 2 generic drugs cost $8 per month at preferred locations, with no copay for a three-month supply via preferred mail order, compared to a $20 monthly copay at standard pharmacies. Tier 3 preferred brand-name drugs have a consistent $47 monthly copay regardless of whether you choose a preferred or standard pharmacy or mail order service. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply across all pharmacy types.
Additional Benefits
The HealthSpring Premier (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, routine physical exams, and home health services. For specialized medical care, members pay a $25 copay for specialist visits and a $150 copay for emergency room services, which is waived if hospitalized. Inpatient hospital stays require a $295 daily copay for the first six days, after which there is no copay for days seven through ninety. This plan also includes additional benefits such as preventive and comprehensive dental care with no copay up to a $1,000 annual maximum. Routine eye exams are available with no copay up to a $30 copay, alongside eyewear coverage up to a $175 yearly limit. Furthermore, diagnostic lab services and outpatient X-rays are available with no copay, while medical equipment and dialysis services require a 20% coinsurance and no copay.
Inpatient Hospital See details
HealthSpring Premier (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and additional days, upgrades, or non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSpring Premier (HMO-POS) covers outpatient services with no coinsurance, featuring a $0 to $295 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services have no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
HealthSpring Premier (HMO-POS) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
HealthSpring Premier (HMO-POS) covers ground ambulance services with a $245.00 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Transportation services are technically covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
HealthSpring Premier (HMO-POS) covers emergency services with a $150 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 up to a $50,000 maximum benefit with a $150 copay and no coinsurance.
Primary Care See details
HealthSpring Premier (HMO-POS) provides primary care physician services with no copay and no coinsurance, while specialist visits, therapy services, and mental health care require a $25 copay and no coinsurance. Telehealth benefits are covered with a $0 to $25 copay and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
HealthSpring Premier (HMO-POS) offers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay or coinsurance, including fitness benefits and caregiver support, while services like health education, nutritional/dietary benefits, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services covered by HealthSpring Premier (HMO-POS) include annual routine exams and fitting evaluations for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with a $399 to $1,800 copay and no coinsurance, excluding inner ear, outer ear, and over the ear types, while OTC hearing aids are covered with a $399 copay and no coinsurance.
Vision Services See details
HealthSpring Premier (HMO-POS) provides partially covered vision services, offering one routine eye exam per year with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $175 annual maximum for contacts or one pair of lenses, frames, and upgrades.
Dental Services See details
HealthSpring Premier (HMO-POS) covers dental services, offering preventive and comprehensive care with no copay and no coinsurance up to a $1,000 yearly maximum. Medicare-covered dental services are available with a $25 copay and no coinsurance, though prior authorization is required.
Home Infusion bundled Services See details
HealthSpring Premier (HMO-POS) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by HealthSpring Premier (HMO-POS) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
HealthSpring Premier (HMO-POS) partially covers medical equipment with no copay and a 20% coinsurance, with prior authorization required for services. While durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered, diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSpring Premier (HMO-POS) with no coinsurance, though prior authorization is required. Lab services and outpatient X-rays have no copay, while diagnostic tests range from a $0 to $150 copay, and therapeutic radiological services require a minimum $85 copay.
Home Health Services See details
Home Health Services are covered by HealthSpring Premier (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
HealthSpring Premier (HMO-POS) offers Cardiac Rehabilitation Services with no coinsurance, but only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSpring Premier (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $20 copay for days 1 through 20 and a $218 copay for days 21 through 100 per stay. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSpring Premier (HMO-POS) partially covers other services, providing a meal benefit for chronic illnesses or qualifying medical conditions with no copay and no coinsurance. Acupuncture and over-the-counter (OTC) items are not covered under this plan.
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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.
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