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Sonder Dual Complete (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sonder Dual Complete (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sonder Dual Complete (HMO D-SNP) in 2025, please refer to our full plan details page.
Sonder Dual Complete (HMO D-SNP) is a HMO D-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 Dual Complete (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Sonder Dual Complete (HMO D-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 Dual Complete (HMO D-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 Dual Complete (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $0.40. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 Dual Complete (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. After the deductible, you will pay 25% coinsurance for many drugs, depending on the tier and the pharmacy you use. If you qualify for the low-income subsidy (LIS), you'll pay $40.00.
Additional Benefits
The Sonder Dual Complete (HMO D-SNP) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying coinsurance amounts. Primary care, preventive, hearing, vision, and dental services are covered, with some services having no copay. The plan also provides coverage for ambulance, transportation, emergency services, home health, medical equipment, and home infusion. Additional perks include coverage for OTC items up to $300 every three months, and a meal benefit for chronic illnesses. However, some services like cardiac rehabilitation, worldwide emergency services, and certain transportation services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with prior authorization required. Additional Days for Inpatient Hospital-Acute is covered with no coinsurance, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services and observation services, each with a 20% coinsurance, as well as ambulatory surgical center (ASC) services with a coinsurance between 20% and 20%. Outpatient substance abuse services are partially covered, with group sessions covered at a 20% coinsurance, and individual sessions not covered. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Sonder Dual Complete (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Sonder Dual Complete (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and there is no copay. Transportation Services to plan-approved health-related locations are covered for 50 one-way trips per year using rideshare services, bus/subway, or medical transport, but transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Sonder Dual Complete (HMO D-SNP) plan. Emergency and Urgently Needed Services have a 20% coinsurance, while Worldwide Emergency Services are not covered.
Primary Care See details
The Sonder Dual Complete (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy, specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, specialist services, and physical therapy and speech-language pathology services have a 20% coinsurance. Chiropractic services and routine foot care have a 20% coinsurance. Occupational therapy, individual and group mental health and psychiatric sessions, other health professional services, and opioid treatment program services have a minimum and maximum 20% coinsurance.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and services like an annual physical exam with 20% coinsurance, in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, fitness benefits, remote access technologies, and support for caregivers. Other services like health education, medical nutrition therapy, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking cessation, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered. Kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit are covered with 20% coinsurance.
Hearing Services See details
Hearing services include routine hearing exams once per year, with no copay, and prescription hearing aids (all types) with no copay; however, fitting/evaluation for hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, prescription hearing aids - over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams once per year, and eyewear. This plan covers contact lenses and eyeglasses (lenses and frames), but does not cover eyeglass lenses, eyeglass frames, or upgrades.
Dental Services See details
The Sonder Dual Complete (HMO D-SNP) plan covers Medicare dental services with 20% coinsurance, and covers other dental services up to a maximum of $5,000 per year. Other dental services include oral exams (1 visit every six months), dental x-rays (1 visit every two years), other diagnostic dental services, prophylaxis (cleaning) (1 visit every six months), fluoride treatment (1 visit every six months), other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable), maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery. Adjunctive general services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $10 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Sonder Dual Complete (HMO D-SNP) plan, but require prior authorization. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment is covered, with no copay. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Sonder Dual Complete (HMO D-SNP) plan. Diagnostic Procedures/Tests and Lab Services have no copay, with a coinsurance of at most 20%, while Diagnostic, Therapeutic Radiological Services, and Outpatient X-Ray Services have no copay, with a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Sonder Dual Complete (HMO D-SNP) plan with no copay and no coinsurance, but a referral is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Sonder Dual Complete (HMO D-SNP) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Sonder Dual Complete (HMO D-SNP) plan, but prior authorization is required. The plan does not cover additional days beyond Medicare-covered SNF days or non-Medicare-covered SNF stays.
Other Services See details
The Sonder Dual Complete (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $300 every three months, but 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 offers a meal benefit for chronic illnesses.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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