Medicare Pre-Enrollment Disclaimers
We are here to support you at every step of the enrollment process. Before you select and enroll in your chosen HealthSpring plan, here is helpful information to know.
All HealthSpring Medicare Plans
HealthSpring products and services are provided exclusively by or through operating subsidiaries of Health Care Service Corporation, a Mutual Legal Reserve Company.
Contact plan for details and availability of these services. This information is not a complete description of benefits. Please contact our Customer Service on our contact us page for additional information.
The disclaimers on this page apply to the benefits outlined throughout plan documents. Benefits vary by plan. Prior authorization and/or referrals are required for certain services.
Benefits, formulary (drug list), pharmacy network, premiums and/or copayments/co-insurance may change on January 1.
Every year, Medicare evaluates plans based on a 5-star rating system.
Copays and some limits may apply.
You can only be enrolled in one Medicare Advantage Plan at a time.
Medicare beneficiaries may also enroll in HealthSpring plans through the Centers for Medicare and Medicaid Services (CMS) Online Enrollment Center.
ATTENTION: If you speak you speak a language other than English, free language assistance services are available to you. Appropriate auxiliary aids and services to provide information in accessible formats are also available free of charge. If needed, please review our Notice of Availability for language assistance.
Arizona HealthSpring Medicare Advantage Plans
HealthSpring Achieve (HMO C-SNP) Medicare Plan H0354-027
To be eligible for this plan and maintain coverage, you must be clinically diagnosed with cardiovascular disorders, chronic heart failure or diabetes. You also must live in our service area of Maricopa, Pima and Pinal counties in Arizona and be enrolled in Medicare Parts A and B.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that focuses on certain vulnerable groups of Medicare beneficiaries. SNPs are required to submit a Model of Care (MOC) to the Centers for Medicare & Medicaid Services (CMS) for review and approval by the National Committee for Quality Assurance (NCQA). HealthSpring has received 3-year approvals for our Dual-Eligible SNP (D-SNP) contracts, which is the maximum approval period. HealthSpring has received 1-year approvals for our Chronic SNP (C-SNP) contracts, which require an annual submission. If you have questions regarding our approval by the NCQA, please contact our Customer Service Team at
Special Supplemental Benefit for Chronically Ill (SSBCI) members only: To be eligible to receive this benefit, you must be diagnosed with cardiovascular disorders, chronic heart failure or diabetes. Other eligibility and coverage criteria apply. Contact the plan for more information.
HealthSpring has a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call
HealthSpring Alliance (HMO) H0354-028, HealthSpring Preferred (HMO) H0354-001, HealthSpring Preferred Savings (HMO) H0354-029, HealthSpring Preferred Full Savings (HMO) H0354-030, and HealthSpring True Choice (PPO) H7849-065
To enroll in one of the above plans, you must live in our service area of Maricopa, Pima and Pinal counties in Arizona.
With Arizona HealthSpring Medicare Advantage plans, you'll get all primary and most specialty care through the Evernorth Care GroupSM network. You can also go to select local doctors. You must use doctors in your plan, except with:
- An emergency
- Urgent care visits
- Renal dialysis that’s not in your area
If you get routine care from doctors outside your network, you will be charged for the costs.
For Arizona residents only:
Call Customer Service at
Individual Plan Disclaimers
Select your plan below to see the applicable disclaimers.
Medicare Advantage Plans
HealthSpring Achieve (HMO C-SNP) Medicare Plan
To be eligible for this plan and maintain coverage, you must be clinically diagnosed with cardiovascular disorders, chronic heart failure or diabetes. You also must live in our service area and be enrolled in Medicare Parts A and B.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that focuses on certain vulnerable groups of Medicare beneficiaries. SNPs are required to submit a Model of Care (MOC) to the Centers for Medicare & Medicaid Services (CMS) for review and approval by the National Committee for Quality Assurance (NCQA). HealthSpring has received 3-year approvals for our Dual-Eligible SNP (D-SNP) contracts, which is the maximum approval period. HealthSpring has received 1-year approvals for our Chronic SNP (C-SNP) contracts, which require an annual submission. If you have questions regarding our approval by the NCQA, please contact our Customer Service Team at
Special Supplemental Benefit for Chronically Ill (SSBCI) members only: To be eligible to receive this benefit, you must be diagnosed with cardiovascular disorders, chronic heart failure or diabetes. Other eligibility and coverage criteria apply. Contact the plan for more information.
HealthSpring has a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call
HealthSpring Alliance (HMO) Medicare Plan
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
HealthSpring has a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call
HealthSpring Courage (HMO) Medicare Plan
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
HealthSpring Preferred (HMO) Medicare Plans
HealthSpring Preferred (HMO), HealthSpring Preferred AL (HMO), HealthSpring Preferred Full Savings Medicare (HMO), HealthSpring Preferred GA (HMO), HealthSpring Preferred PA (HMO), HealthSpring Preferred Plus (HMO), HealthSpring Preferred Savings (HMO), and HealthSpring Preferred Select (HMO):
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
HealthSpring has a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call
HealthSpring Premier (HMO-POS) Medicare Plan
For PPO and POS plans, out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. Please call our Customer Service number or review your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
HealthSpring has a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call
HealthSpring Primary (HMO) Medicare Plan
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
HealthSpring has a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call
HealthSpring TotalCare (HMO D-SNP) Medicare Plans
HealthSpring TotalCare (HMO D-SNP) and HealthSpring TotalCare Plus (HMO D-SNP).
To join these plans, you must be entitled to Medicare Part A and be enrolled in Medicare Part B and Medicaid.
HealthSpring TotalCare plans are available to anyone who has both Medical Assistance from the State (Medicaid) and Medicare. Premiums, copays, coinsurance, deductibles and benefits may vary based on the level of Medicaid and Extra Help you receive. Contact the plan for more information.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that focuses on certain vulnerable groups of Medicare beneficiaries. SNPs are required to submit a Model of Care (MOC) to the Centers for Medicare & Medicaid Services (CMS) for review and approval by the National Committee for Quality Assurance (NCQA). HealthSpring has received 3-year approvals for our Dual-Eligible SNP (D-SNP) contracts, which is the maximum approval period. HealthSpring has received 1-year approvals for our Chronic SNP (C-SNP) contracts, which require an annual submission. If you have questions regarding our approval by the NCQA, please contact our Customer Service Team at
Special Supplemental Benefit for Chronically Ill (SSBCI) members only: To be eligible to receive this benefit, you must be diagnosed with cardiovascular disorders, chronic heart failure, chronic lung disorders, diabetes or stroke. Other eligibility and coverage criteria apply. Contact the plan for more information.
HealthSpring has a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call
HealthSpring True Choice (PPO) Medicare Plans
HealthSpring True Choice (PPO), HealthSpring True Choice Plus (PPO), and HealthSpring True Choice Savings (PPO).
For PPO and POS plans, out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our Customer Service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
HealthSpring has a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call
Part D Prescription Drug Plans
HealthSpring Assurance Rx (PDP) Medicare Plan
HealthSpring has a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call
HealthSpring Extra Rx (PDP) Medicare Plan
HealthSpring has formed a network of pharmacies for our Medicare plans, including pharmacies with preferred cost-sharing. You must use a network pharmacy to access your prescription drug benefits, except under non-routine circumstances, and quantity limitations and restrictions may apply. If you get drugs from an out-of-network pharmacy, you may pay more than you pay at an in-network pharmacy. You will pay the copay or percent of the cost, plus the difference between the out-of-network pharmacy billed charge and our typical Standard Retail pharmacy billed costs. The pharmacies in our network can change at any time.
For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, please call