2027 Medicare Advantage plan

HealthSpringSM Primary (HMO): 2027 benefits and costs

HealthSpringSM HMO

CMS plan ID: H4513-035-0 · Plan year: 2027

HealthSpringSM Primary (HMO) is a 2027 Medicare Advantage plan offered by HealthSpringSM. It is listed in Tennessee.

2027 plan costs at a glance

Monthly plan premium$13.70
Drug deductible$700.00
In-network medical out-of-pocket maximum$5,200.00
Organization
HealthSpringSM
Plan organization
HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC.
Parent company
Health Care Service Corporation
Plan type
HMO
Part C premium
$0.00
Part D premium
$13.70
Prescription drug coverage
Yes
2027 CMS Star Rating
Standard monthly Medicare Part B premium
$209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible
None
In-network medical maximum
$5,200.00

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
ServiceIn-networkWhat to know
Primary care doctor

$0

Service-specific deductible
No
Specialist visit

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No
Telehealth

$0.00 to $10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Emergency care

$130.00 copay

Urgent care

$50.00 copay

Home health

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No
Dialysis

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
No
Part B chemotherapy and radiation drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Other Part B drugs

0% to 20% coinsurance

Deductible applies
No
Approval required
Yes
Kidney disease education services

$0

Service-specific deductible
No
Approval required
No
Referral required
No
Medicare-covered chiropractic

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No
Medicare-covered foot care

$0

Service-specific deductible
No
Approval required
No
Referral required
No
Other health professionals

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–6: $285.00 copay per day

Days 7–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Inpatient mental health care

$0.00 copay per stay

Days 1–6: $285.00 copay per day

Days 7–90: $0.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay
Skilled nursing facility

Days 1–20: $10.00 copay per day

Days 21–100: $221.00 copay per day

Approval required
Yes
Referral required
No
Benefit period
Per Admission or Per Stay

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkWhat to know
Outpatient hospital care

$0.00 to $285.00 copay

Service-specific deductible
No
Hospital observation services

$285.00 copay

Service-specific deductible
No
Ambulatory surgical center

$0.00 to $285.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Outpatient blood

$0

Service-specific deductible
No
Approval required
No
Referral required
No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
ServiceIn-networkWhat to know
Diagnostic procedures and tests

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No
Laboratory services

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
No
Diagnostic radiology (CT, MRI)

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No
Therapeutic radiology

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Referral required
No
X-rays

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
ServiceIn-networkWhat to know
Partial hospitalization

$155.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Intensive outpatient program

$155.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Substance use treatment, individual sessions

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No
Substance use treatment, group sessions

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No
Opioid treatment program

$0

Service-specific deductible
No
Approval required
Yes
Referral required
No
Mental health, individual sessions

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Mental health, group sessions

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Psychiatry, individual sessions

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Psychiatry, group sessions

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkWhat to know
Occupational therapy

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Physical and speech therapy

$10.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Cardiac rehabilitation

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Intensive cardiac rehabilitation

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Pulmonary rehabilitation

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No
Supervised exercise for peripheral artery disease

$25.00 copay

Service-specific deductible
No
Approval required
Yes
Referral required
No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
ServiceIn-networkWhat to know
Ground ambulance

$225.00 copay

Service-specific deductible
No
Approval required
Yes
Air ambulance

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Durable medical equipment

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Medical supplies

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic supplies

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic shoes and inserts

20% coinsurance

Service-specific deductible
No
Approval required
Yes
Diabetic monitors

0% to 20% coinsurance

Service-specific deductible
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered dental

$0

Oral examsAdditional plan benefit

$0

Dental X-raysAdditional plan benefit

$0

Other diagnostic dentalAdditional plan benefit

$0

Dental cleaningAdditional plan benefit

$0

FluorideAdditional plan benefit

$0

Other preventive dentalAdditional plan benefit

$0

Restorative dental careAdditional plan benefit

$0

Root canal treatment (endodontics)Additional plan benefit

$0

Gum treatment (periodontics)Additional plan benefit

$0

Removable dentures (prosthodontics)Additional plan benefit

$0

Maxillofacial prostheticsAdditional plan benefit

$0

Dental implantsAdditional plan benefit

$0

Fixed dental restorations (prosthodontics)Additional plan benefit

$0

Oral surgeryAdditional plan benefit

$0

OrthodonticsAdditional plan benefit

$0

Other dental servicesAdditional plan benefit

$0

Vision benefits

Vision benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered eye exams

$0

Service-specific deductible
No
Approval required
No
Referral required
No
Routine eye examsAdditional plan benefit

$0

Approval required
No
Referral required
No
Medicare-covered eyewear

$0

Service-specific deductible
No
Approval required
No
Referral required
No
Contact lensesAdditional plan benefit

$0

Approval required
No
Referral required
No
Eyeglasses, lenses and framesAdditional plan benefit

$0

Approval required
No
Referral required
No
Eyeglass lensesAdditional plan benefit

$0

Approval required
No
Referral required
No
Eyeglass framesAdditional plan benefit

$0

Approval required
No
Referral required
No

Hearing benefits

Hearing benefits and member costs
ServiceIn-networkWhat to know
Medicare-covered hearing exams

$0

Service-specific deductible
No
Approval required
No
Referral required
No
Routine hearing examsAdditional plan benefit

$0

Approval required
No
Referral required
No
Hearing aid fitting and evaluationAdditional plan benefit

$0

Approval required
No
Referral required
No
Prescription hearing aids (all types)Additional plan benefit

$399.00 to $1,800.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No
Over-the-counter hearing aidsAdditional plan benefit

$399.00 copay

Service-specific deductible
No
Approval required
No
Referral required
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkWhat to know
Over-the-counter health itemsAdditional plan benefit

$0

Service-specific deductible
No
Limited-duration mealsAdditional plan benefit

$0

Service-specific deductible
No
Approval required
No
Referral required
No
Annual physical examAdditional plan benefit

$0

Service-specific deductible
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0

Service-specific deductible
No
Approval required
No
Referral required
No

Prescription drug coverage

Costs shown are for initial coverage.

This plan uses a non-tiered standard drug benefit; individual drug prices are not listed here.

Available prescription supply lengths, not price quotes
PharmacySupply
Standard retail30 days
Standard retail60 days
Standard retail90 days
Standard mail order30 days
Standard mail order60 days
Standard mail order90 days
Out-of-network pharmacy30 days
Long-term care pharmacy31 days

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

View all locations 16 county listings across 1 state or territory

Tennessee