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Sonder Breathe Well (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sonder Breathe Well (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 Breathe Well (HMO C-SNP) in 2025, please refer to our full plan details page.
Sonder Breathe Well (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 Breathe Well (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 Breathe Well (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 Breathe Well (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 Breathe Well (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 $1.50. 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 Breathe Well (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays depending on the drug tier and the pharmacy you use. For example, standard generic drugs have a $15 copay, while preferred brand drugs have 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. If you qualify for the low-income subsidy (LIS), you will pay $0.00 for your Part D drugs.
Additional Benefits
The Sonder Breathe Well (HMO C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays depending on the specific service. You'll have access to primary care, preventive services, hearing and vision services, and dental services with some cost-sharing through copays or coinsurance. Emergency, ambulance, and transportation services are also covered, alongside home health, skilled nursing, and dialysis services. The plan also provides coverage for durable medical equipment, diagnostic and radiological services, and home infusion services. Additional benefits include coverage for partial hospitalization, cardiac rehabilitation, and over-the-counter items. However, it's important to note that certain services like annual physical exams, hearing aids, and some dental procedures may have limitations or may not be covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $350 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you'll also pay a $350 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and the Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient substance abuse services, are covered. Outpatient hospital services have a $280 copay, observation services have a $350 copay, ambulatory surgical center services have a $180 copay, and individual and group sessions for outpatient substance abuse have a copay between $75 and $75.
Partial Hospitalization See details
Partial Hospitalization is covered by the Sonder Breathe Well (HMO C-SNP) plan, but requires prior authorization. You will have a $10 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Sonder Breathe Well (HMO C-SNP) plan. Ground ambulance services have a $225 copay, and air ambulance services have a $450 copay, with no coinsurance. Transportation services to a plan-approved health-related location are covered for up to 50 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay and no coinsurance, while Urgently Needed Services have a $25 copay and 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
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $20 copay, Occupational Therapy Services and Mental Health Specialty Services have a $40 copay, Other Health Care Professional services have a $35 copay, Physical Therapy and Speech-Language Pathology Services have a $40 copay, and Opioid Treatment Program Services have a $30 copay.
Preventive Services See details
The Sonder Breathe Well (HMO C-SNP) plan covers preventive services, including Medicare-covered preventive services with no copay. Additional preventive services include in-home safety assessments, personal emergency response systems, post-discharge in-home medication reconciliation, support for caregivers, additional smoking cessation counseling, fitness benefits, remote access technologies, and alternative therapies with 6 visits covered. Other preventive services include glaucoma screening, diabetes self-management training, barium enemas with 20% coinsurance, digital rectal exams, and EKG following a Welcome Visit. The plan does not cover 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, enhanced disease management, telemonitoring services, home and bathroom safety devices, counseling services, or home-based palliative care.
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 depending on the type of aid. Fitting/evaluation for hearing aids, prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with a $30 copay. Eyewear is covered, with a combined maximum benefit of $200 every year for contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Sonder Breathe Well (HMO C-SNP) plan covers Medicare Dental Services with 20% coinsurance, and other dental services with a $2,500 maximum benefit per year. Oral exams, fluoride treatments, and prophylaxis (cleaning) are covered, with limitations on the number of visits and periodicity, while dental X-rays are limited to 1 every two years. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable), Maxillofacial Prosthetics, Prosthodontics (fixed), and Oral and Maxillofacial Surgery are also covered. However, Adjunctive General Services, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Sonder Breathe Well (HMO C-SNP) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 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 under the Sonder Breathe Well (HMO C-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Sonder Breathe Well (HMO C-SNP) plan, with Durable Medical Equipment (DME) covered with a coinsurance between 0% and 20% and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are covered, each with a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Sonder Breathe Well (HMO C-SNP) plan. Diagnostic procedures/tests, lab services, and outpatient X-ray services are not covered, while diagnostic radiological services have a copay of up to $275, and therapeutic radiological services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the Sonder Breathe Well (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 there is no copay information available, and the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Additional Cardiac Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Sonder Breathe Well (HMO C-SNP), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $184 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Sonder Breathe Well (HMO C-SNP) plan covers Over-the-Counter (OTC) items, with a maximum benefit of $200 every three months. The plan also offers a Meal Benefit for a chronic illness. However, 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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