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Sonder Vitality Matters (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sonder Vitality Matters (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sonder Vitality Matters (HMO) in 2025, please refer to our full plan details page.
Sonder Vitality Matters (HMO) is a HMO 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 Vitality Matters (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 Sonder Vitality Matters (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 Sonder Vitality Matters (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. Additionally, this plan comes with a Part B Premium reduction of $0.60. 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 Vitality Matters (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, you'll pay a $10 copay for a preferred generic drug at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. This plan may also reduce your premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Sonder Vitality Matters (HMO) plan provides coverage for a range of healthcare services. This plan includes coverage for inpatient hospital stays with a copay, as well as outpatient services, and emergency services with varying copays. It also covers services such as primary care, hearing, vision, dental, and home health services, with specific copays and limitations for each. Additional benefits of this plan include ambulance and transportation services, and home infusion bundled services. The plan also includes coverage for medical equipment, dialysis services, and diagnostic and radiological services. The plan offers some additional benefits such as over-the-counter items and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For days 1-5, 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. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services are covered under the Sonder Vitality Matters (HMO) plan, including outpatient hospital services with a copay between $0 and $280, observation services with a $350 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual sessions with a $25 copay and group sessions with a $15 copay. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Sonder Vitality Matters (HMO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Sonder Vitality Matters (HMO) plan. Ground ambulance services have a $225 copay, while air ambulance services have a $750 copay; both have no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 50 one-way trips per year via rideshare services, bus/subway, or medical transport, and have no copay or coinsurance. 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 under the Sonder Vitality Matters (HMO) plan. Emergency Services have a $125 copay and Urgently Needed Services have a $30 copay, while all other services have no coinsurance.
Primary Care See details
The Sonder Vitality Matters (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services, mental health services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits, and opioid treatment program services with a $25 copay. Routine Chiropractic Care and Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, additional preventive services, and other preventive services, but annual physical exams, health education, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, and counseling services are not covered. Other services, like Barium Enemas, have a $60 copay.
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 for all types of hearing aids, but 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. Routine hearing exams are limited to one per year.
Vision Services See details
Vision services include coverage for eye exams with a $30 copay, and eyewear, with a combined maximum of $200 per year for contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Sonder Vitality Matters (HMO) plan offers a dental benefit with a $2,000 annual maximum. Oral exams, prophylaxis (cleaning), and fluoride treatments are limited to one visit every six months, while dental X-rays are limited to one every two years. Other diagnostic dental services, restorative services, endodontics, periodontics, prosthodontics (removable, fixed), maxillofacial prosthetics, and oral and maxillofacial surgery are covered with no visit limits, while 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 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 with a 20% coinsurance, and require prior authorization and a doctor's referral.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the Sonder Vitality Matters (HMO) plan. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medicare-covered Prosthetic Devices, Medicare-covered Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a doctor referral required. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $300, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Sonder Vitality Matters (HMO) 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 not covered by the Sonder Vitality Matters (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $184.
Other Services See details
The Sonder Vitality Matters (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $125 every three months, and Meal Benefits 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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