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Sonder Diabetes Wellness (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sonder Diabetes Wellness (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sonder Diabetes Wellness (HMO C-SNP) in 2025, please refer to our full plan details page.
Sonder Diabetes Wellness (HMO C-SNP) is a HMO C-SNP plan offered by Avian Health Holdings, LLC available for enrollment in 2025 to people living in Central Georgia Areas. This plan received an overall rating of 2 out of 5 stars in 2025.
It's important to know that Sonder Diabetes Wellness (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Sonder Diabetes Wellness (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Sonder Diabetes Wellness (HMO C-SNP).
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 Sonder Diabetes Wellness (HMO C-SNP), 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. Additionally, this plan comes with a Part B Premium reduction of $1.90. You must continue to pay paying your reduced 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 $3950.00 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 Sonder Diabetes Wellness (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays for your prescriptions depending on the drug tier and pharmacy used. For example, you will pay a $15 copay for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), also known as "Extra Help".
Additional Benefits
The Sonder Diabetes Wellness (HMO C-SNP) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays for specific services like hospital visits and substance abuse treatment. The plan also covers services like ambulance, emergency care, and vision and hearing exams, with specific copays. This plan provides coverage for dental services with coinsurance and an annual limit, along with home health services and skilled nursing facilities with copays. Additionally, the plan includes coverage for medical equipment with coinsurance, home infusion services, and diagnostic services, along with a quarterly allowance for over-the-counter items and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 5 days of an Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stay, there is a $350 copay, and for days 6-90, there is no copay; additional days for Inpatient Hospital-Acute are covered with no copay, and non-Medicare covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a $280 copay, observation services with a $350 copay, and ambulatory surgical center services with a $180 copay. Outpatient substance abuse services are covered with a $75 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Sonder Diabetes Wellness (HMO C-SNP) plan, with a $10 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Sonder Diabetes Wellness (HMO C-SNP) plan, with a $225 copay for ground ambulance services and a $450 copay for air ambulance services. Transportation services to plan-approved health-related locations are covered for up to 12 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services have a $120 copay, and Urgently Needed Services have a $25 copay; all other services have no copay, and no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $10,000.
Primary Care See details
The Sonder Diabetes Wellness (HMO C-SNP) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services, mental health specialty services with a $40 copay for individual and group sessions, podiatry services, other health care professional services with a $35 copay, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, additional telehealth benefits, and opioid treatment program services with a $30 copay. Routine chiropractic care is limited to 12 visits per year.
Preventive Services See details
Preventive services include coverage for services such as In-Home Safety Assessments, Personal Emergency Response Systems, Post discharge In-Home Medication Reconciliation, Alternative Therapies (6 visits), Fitness Benefits (Memory Fitness), Remote Access Technologies, Home and Bathroom Safety Devices, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas (20% coinsurance), Digital Rectal Exams, and EKGs following a Welcome Visit. Annual physical exams, health education, medical nutrition therapy, re-admission prevention, wigs for hair loss, weight management programs, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $30 copay, and prescription hearing aids with a copay between $699 and $999, while fitting/evaluation for hearing aids, and OTC hearing aids are not covered. Routine hearing exams are limited to 1 per year.
Vision Services See details
Vision services include coverage for eye exams with a $30 copay. Eyewear has a combined maximum benefit of $200 per year for contact lenses and eyeglasses (lenses and frames), while eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Sonder Diabetes Wellness (HMO C-SNP) plan offers dental services with a 20% coinsurance for Medicare Dental Services and covers up to $2,500 per year for other dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are limited to 1 visit every six months, every two years, every six months, and every six months, respectively. Other diagnostic dental services, restorative services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, prosthodontics (fixed), and oral and maxillofacial surgery are covered. Adjunctive general services, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%, while Medicare Part B Insulin Drugs are also covered.
Dialysis Services See details
Dialysis Services are covered under the Sonder Diabetes Wellness (HMO C-SNP) plan, but require prior authorization. There is no information about the cost of these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered. DME has a 20% coinsurance, and Prosthetic Devices also have a 20% coinsurance, while Medical Supplies have a 20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay up to $275, and Therapeutic Radiological Services have a coinsurance of 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Sonder Diabetes Wellness (HMO C-SNP) plan with a $10 copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Sonder Diabetes Wellness (HMO C-SNP) plan, but require prior authorization. You will have no copay for days 1-20, and a $184 copay for days 21-100.
Other Services See details
The Sonder Diabetes Wellness (HMO C-SNP) plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $150 every three months. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. The plan also provides a meal benefit for chronic illnesses.
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