HealthSun MediMax (HMO)

HealthSun MediMax (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Broward, Miami-Dade. This plan received an overall rating of 4.5 out of 5 stars in 2026.

It's important to know that HealthSun MediMax (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 HealthSun MediMax (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.

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:

Drug Coverage

The HealthSun MediMax (HMO) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, there is no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs filled at standard pharmacies or through standard mail order. This ensures no-cost access to many common medications. For other drug tiers, the plan charges a $10 copay for Tier 3 preferred brand drugs and a $50 copay for Tier 4 non-preferred drugs for a one-month supply. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply at standard pharmacies and standard mail order. These defined copayments and coinsurance rates apply to both standard retail pharmacy and standard mail order purchases.

Additional Benefits

The HealthSun MediMax (HMO) plan offers comprehensive medical coverage with no copay and no coinsurance for most primary care, specialist visits, inpatient and outpatient hospital stays, and emergency services. Beneficiaries also benefit from no copays on diagnostic tests, medical equipment, and skilled nursing facility stays for up to 100 days. While most medical services require no out-of-pocket costs, dialysis services require a 20% coinsurance, and Medicare Part B drugs carry a coinsurance of 0% to 20%. This plan also includes robust supplemental benefits with no copays or coinsurance, including routine vision exams with a $400 annual eyewear allowance and routine hearing exams with a $2,000 annual prescription hearing aid allowance. Dental care is covered up to a $5,000 annual maximum with no copay, and members receive a $90 monthly over-the-counter allowance. Additionally, the plan offers unlimited transportation to approved medical locations and home health services at no cost to the member.