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Health First SunSaver H1099-016 (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Health First SunSaver H1099-016 (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Health First SunSaver H1099-016 (HMO) in 2026, please refer to our full plan details page.
Health First SunSaver H1099-016 (HMO) is a HMO plan offered by Health First Shared Services, Inc. available for enrollment in 2025 to people living in Flagler Hardee Highlands Volusia. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Health First SunSaver H1099-016 (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 Health First SunSaver H1099-016 (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 Health First SunSaver H1099-016 (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3500.00 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 Health First SunSaver H1099-016 (HMO) Medicare plan features a $0 drug deductible, meaning your drug coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs at both preferred and standard pharmacies, as well as via standard mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a 1-month supply at preferred pharmacies or no copay for a 3-month supply through standard mail order. For higher-tier medications, this plan transitions to copayments and coinsurance. Tier 3 preferred brand drugs cost a $42 copay for a 1-month supply at preferred pharmacies, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs carry a 33% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Health First SunSaver H1099-016 (HMO) plan offers comprehensive medical coverage featuring no copay for primary care doctor visits, annual physicals, and home health services. For specialist visits, members will pay a $20 copay, while inpatient hospital stays require a daily copay for the first eight days with no coinsurance. Emergency care is accessible with a $150 copay, which is waived upon hospital admission, and urgent care carries a $25 copay. Supplemental benefits are highly accessible, featuring no copay for routine dental care up to a $1,000 annual limit and no copay for routine eye exams and eyewear up to $400 yearly. Additionally, members receive a $130 quarterly over-the-counter allowance and no copay for up to 32 health-related transit trips per year. Prescription hearing aids are also covered with no copay up to a $1,000 limit every two years.
Inpatient Hospital See details
Health First SunSaver H1099-016 (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $160 daily copay for days 1 through 8 (no copay for days 9 through 90) for acute stays and a $191 daily copay for days 1 through 8 (no copay for days 9 through 90) for psychiatric stays. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by Health First SunSaver H1099-016 (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Medicare-covered outpatient hospital services have a copay ranging from $0 to $150, observation services carry a $175 copay per stay, and outpatient substance abuse sessions require a $20 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Health First SunSaver H1099-016 (HMO) with a $15.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Health First SunSaver H1099-016 (HMO) covers ground and air ambulance services with a $260 copay and no coinsurance. Transportation services are partially covered, excluding plan-approved health-related location services, but providing up to 32 one-way trips per year to any health-related location via bus or subway with no copay or coinsurance.
Emergency Services See details
Emergency services are covered under the Health First SunSaver H1099-016 (HMO) plan with a $150 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, while urgently needed services require a $25 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays ranging from $150 to $260, up to a maximum plan benefit of $50,000.
Primary Care See details
Health First SunSaver H1099-016 (HMO) offers partially covered primary care benefits, featuring no copay and no coinsurance for primary care doctor visits and a $20 copay with no coinsurance for specialists. Therapy services require a $10 copay and no coinsurance, but podiatry, routine chiropractic, and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by Health First SunSaver H1099-016 (HMO) with no coinsurance and generally no copay, including annual physical exams, kidney disease education, and glaucoma screenings. While fitness benefits and medical nutrition therapy are covered, several additional services like health education, weight management, and in-home safety assessments are not covered. An EKG following a Welcome Visit is covered with a $35 copay and no coinsurance.
Hearing Services See details
Hearing services covered by Health First SunSaver H1099-016 (HMO) include Medicare-covered exams for a $35 copay and no coinsurance, as well as annual routine exams and fitting evaluations with no copay or coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $1,000 limit every two years, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by Health First SunSaver H1099-016 (HMO) with no deductible and no coinsurance. One routine eye exam per year and eyewear (up to a $400 annual limit) are offered with no copay, while other covered eye exams require a $15 copay; however, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Health First SunSaver H1099-016 (HMO) covers Medicare-approved dental services with a $30 copay and no coinsurance, while other preventive and comprehensive dental services are offered with no copay and no coinsurance. These additional covered benefits—which include cleanings, x-rays, restorative services, implants, and orthodontics—are subject to a maximum plan benefit coverage of $1,000 every year.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Health First SunSaver H1099-016 (HMO) with no copay, subject to prior authorization and step therapy. Covered Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Health First SunSaver H1099-016 (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Health First SunSaver H1099-016 (HMO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a prior authorization requirement. Members will pay a 20% coinsurance for durable medical equipment and prosthetics, and between 10% and 20% coinsurance for diabetic equipment and supplies.
Diagnostic and Radiological Services See details
Health First SunSaver H1099-016 (HMO) covers diagnostic services with prior authorization, featuring a $35 copay for tests, no copay for lab services, and no coinsurance. Covered radiological services also require prior authorization and include a $35 copay for X-rays, a minimum $100 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Health First SunSaver H1099-016 (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Health First SunSaver H1099-016 (HMO) with no copay and no coinsurance. However, some services are covered in practice as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Health First SunSaver H1099-016 (HMO) covers skilled nursing facility services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20, a $150 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Health First SunSaver H1099-016 (HMO) partially covers other services, providing a chronic illness meal benefit and a $130 quarterly over-the-counter (OTC) reimbursement allowance with no copay and no coinsurance. Acupuncture and other additional services in this category are not covered.
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