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Sonder Medicare Valorous (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Sonder Medicare Valorous (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Sonder Medicare Valorous (HMO) in 2025, please refer to our full plan details page.
Sonder Medicare Valorous (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 Medicare Valorous (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 Medicare Valorous (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 Medicare Valorous (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 $4950.00 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 Medicare Valorous (HMO) plan has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, you will pay a $10 copay for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Sonder Medicare Valorous (HMO) plan offers a range of benefits, including coverage for inpatient hospital stays with a copay, outpatient services with copays, and ambulance services with copays. Preventive services are available with no copay, and the plan also covers hearing exams, vision services, and dental services with varying cost-sharing structures. This plan provides additional benefits such as home health services with no copay, skilled nursing facility care with copays, and other services like acupuncture and a meal benefit. However, it's important to note that some services, like outpatient substance abuse services and certain vision and dental services, are not covered.
Inpatient Hospital See details
The Sonder Medicare Valorous (HMO) plan covers inpatient hospital stays, including acute and psychiatric care. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-6, and no copay for days 7-90, while for Inpatient Hospital Psychiatric, you pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services are covered by the Sonder Medicare Valorous (HMO) plan, including all outpatient hospital services, Ambulatory Surgical Center (ASC) services, and outpatient blood services. Outpatient hospital services have a $300 copay, observation services have a $350 copay, and ASC services have a $180 copay. Outpatient substance abuse services (individual and group sessions) are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Sonder Medicare Valorous (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 Medicare Valorous (HMO) plan. Ground ambulance services have a $225 copay, while air ambulance services have a $750 copay; all ambulance services have no coinsurance. Transportation services to a plan-approved health-related location are covered, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the Sonder Medicare Valorous (HMO) plan. Emergency Services have a $125 copay with no coinsurance, and Urgently Needed Services have a $30 copay with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The Sonder Medicare Valorous (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services, other health care professionals with a $40 copay, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits, and opioid treatment program services. Mental health specialty services, individual sessions for psychiatric services, and podiatry services are not covered.
Preventive Services See details
The Sonder Medicare Valorous (HMO) plan covers preventive services, including those covered by Medicare, with no copay. Additional preventive services like In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Post discharge In-Home Medication Reconciliation, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, and Counseling Services are covered. Other preventive services include Barium Enemas with a $60 copay. The plan does not cover annual physical exams, health education, medical nutrition therapy, re-admission prevention, wigs for hair loss related to chemotherapy, 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 and modifications.
Hearing Services See details
Hearing services are covered, including hearing exams with a $40 copay. Prescription Hearing Aids (all types) are covered, while 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 include routine eye exams and eyewear. Routine eye exams are covered once per year, and eyewear, including contact lenses and eyeglasses (lenses and frames), are covered. Contact lenses have a $40 copay. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The Sonder Medicare Valorous (HMO) plan offers dental services with a 20% coinsurance. Other dental services have a maximum plan benefit coverage of $3,500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Sonder Medicare Valorous (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay. 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 Medicare Valorous (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered. DME has a 20% coinsurance with authorization required, while Durable Medical Equipment for use outside the home is not covered. Prosthetics and Medical Supplies have a 20% coinsurance, and Diabetic Equipment has a 20% coinsurance for Diabetic Supplies and Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay for Medicare-covered lab services, Diagnostic Procedures/Tests with a copay between $0 and $100, and Diagnostic Radiological Services with a copay up to $300. Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the Sonder Medicare Valorous (HMO) plan. There is no copay or coinsurance for home health services, but a referral is required, and additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with prior authorization, but the plan does not cover the specific services of 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. There is a copay for some services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Sonder Medicare Valorous (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $203. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture is covered for up to 12 treatments per year. The plan offers up to $125 for OTC items every three months, and also provides a meal benefit for chronic illnesses. Several additional services are not covered, including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and Case Management (Long Term Care).
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