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Sonder Heart Healthy (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sonder Heart Healthy (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 Heart Healthy (HMO C-SNP) in 2025, please refer to our full plan details page.
Sonder Heart Healthy (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 Heart Healthy (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 Heart Healthy (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 Heart Healthy (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 Heart Healthy (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 $1.80. 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 Heart Healthy (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, a standard generic drug has a $47 copay, while a preferred brand drug has a $100 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Sonder Heart Healthy (HMO C-SNP) plan offers a range of benefits, including inpatient hospital stays with a copay, and outpatient services with varying copays. The plan also covers ambulance services, emergency services, and a wide array of primary care services such as doctor visits, chiropractic, and mental health services. Preventive services like hearing and vision exams, and dental services with coinsurance are also covered. This plan provides coverage for home health services, skilled nursing facilities, and cardiac rehabilitation services. Additional benefits include over-the-counter items, and a meal benefit for chronic illnesses. Diagnostic and radiological services, along with home infusion services, are available with specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a copay of $350 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a $280 copay, observation services with a $350 copay, ambulatory surgical center (ASC) services with a $180 copay, and outpatient substance abuse services with a $75 copay for both individual and group sessions. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Sonder Heart Healthy (HMO C-SNP) plan and requires prior authorization. The copay for this benefit is $10.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Sonder Heart Healthy (HMO C-SNP) plan, with no coinsurance. Ground ambulance services have a copay of $225, while air ambulance services have a $450 copay. Transportation to plan-approved health-related locations is covered for up to 12 one-way trips per year, using rideshare services, bus/subway, or medical transport, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Sonder Heart Healthy (HMO C-SNP) plan. Emergency Services have a $120 copay, and Urgently Needed Services have a $25 copay; both have no coinsurance. Worldwide Emergency Services have a service-specific out-of-pocket maximum of $10,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Sonder Heart Healthy (HMO C-SNP) plan covers primary care physician services, chiropractic services with a $20 copay for routine care, 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 with a $40 copay for routine foot care (6 visits per year), 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.
Preventive Services See details
The Sonder Heart Healthy (HMO C-SNP) plan covers preventive services, including no copay for Medicare-covered preventive services. Additional preventive services include In-Home Safety Assessment, Personal Emergency Response System (PERS), Post discharge In-Home Medication Reconciliation, Alternative Therapies (6 visits), In-Home Support Services, Support for Caregivers of Enrollees, and Fitness Benefit. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas (20% coinsurance), Digital Rectal Exams, and EKG following Welcome Visit. Annual Physical Exams, Health Education, Medical Nutrition Therapy (MNT), Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $30 copay, and coverage for routine hearing exams once per year. This plan also covers prescription hearing aids with a copay between $699 and $999, but does not cover fitting/evaluation for hearing aids, prescription hearing aids for the inner ear, outer ear, or over the ear, or OTC hearing aids.
Vision Services See details
Vision services are covered, including routine eye exams with a $30 copay. Eyewear is covered with a combined maximum benefit of $200 every year, while contact lenses and eyeglasses (lenses and frames) are also covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Sonder Heart Healthy (HMO C-SNP) plan covers dental services with 20% coinsurance for Medicare dental services. Other dental services have a maximum benefit of $2,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Sonder Heart Healthy (HMO C-SNP) plan, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Sonder Heart Healthy (HMO C-SNP) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, but does not cover DME for use outside the home. Medical Supplies and Diabetic Equipment are covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The Sonder Heart Healthy (HMO C-SNP) plan covers diagnostic and radiological services, but diagnostic procedures/tests, lab services, and outpatient X-ray services are not covered. Diagnostic Radiological Services have a copay of up to $275, and Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Sonder Heart Healthy (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 none of the listed sub-services are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Sonder Heart Healthy (HMO C-SNP) plan, but require prior authorization. You will pay no copay for days 1-20, and a $184 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $150 every three months, and a Meal Benefit for chronic illnesses. 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.
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