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HealthSun MediMax (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSun MediMax (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSun MediMax (HMO) in 2025, please refer to our full plan details page.
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 5 out of 5 stars in 2025.
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.
For HealthSun MediMax (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $3450.00 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 HealthSun MediMax (HMO) plan has a $590 deductible for prescription drugs. After meeting the deductible, you'll pay varying costs depending on the drug tier and pharmacy. For preferred and standard generic drugs, you may pay no copay or a $25 copay depending on the pharmacy. For preferred brand and non-preferred drugs, you'll pay 25% coinsurance. For specialty tier drugs, you'll have no copay.
Additional Benefits
The HealthSun MediMax (HMO) plan offers comprehensive coverage with no copays for many services. This includes inpatient and outpatient hospital services, emergency services, primary care, preventive services, hearing, vision, dental, home health, and other services. The plan also provides coverage for ambulance and transportation services, medical equipment, diagnostic and radiological services, and home infusion services.
Inpatient Hospital See details
The HealthSun MediMax (HMO) plan covers inpatient hospital services, including acute and psychiatric care, with no copay for Medicare-covered stays. Additional days, non-Medicare-covered stays, and upgrades for inpatient hospital-acute and psychiatric services are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. There is no copay for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services have no copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the HealthSun MediMax (HMO) plan, with no copay. Prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
The HealthSun MediMax (HMO) plan covers ambulance services with no coinsurance, and a copay for Medicare-covered ground and air ambulance services. Transportation services to a plan-approved health-related location are also covered with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage amount of $100,000.
Primary Care See details
The HealthSun MediMax (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician 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, chiropractic services, physician specialist services, individual and group sessions for mental health specialty services, routine foot care, other health care professional services, individual and group sessions for psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services have no copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered by the HealthSun MediMax (HMO) plan, including Medicare-covered preventive services with no copay, and additional preventive services, with a copay for some services. Annual physical exams are not covered. Services such as Health Education, Personal Emergency Response System (PERS), Alternative Therapies, Therapeutic Massage, Nutritional/Dietary Benefit, and Fitness Benefit have no copay, and Home and Bathroom Safety Devices and Modifications have a maximum plan benefit coverage amount of $75. Other preventive services such as Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay.
Hearing Services See details
Hearing Services include coverage for hearing exams with no copay, including routine hearing exams and fitting/evaluation for hearing aids with no copay, limited to one visit per year. Prescription hearing aids are covered with a plan-specified amount of $2,000 per year with no copay for prescription hearing aids (all types), while prescription hearing aids for inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The HealthSun MediMax (HMO) plan covers vision services, including eye exams and eyewear. Routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames have no copay, while upgrades are not covered. Eyewear has a combined maximum benefit of $400 every year.
Dental Services See details
The HealthSun MediMax (HMO) plan covers dental services, including oral exams, dental x-rays, cleaning, fluoride treatments, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), implant services, and oral and maxillofacial surgery with no copay. Maxillofacial prosthetics, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a copay between $0 and $35, 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 HealthSun MediMax (HMO) plan, requiring prior authorization and a doctor's referral. There is no copay for this service.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no coinsurance and no copay, though Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit covers Medicare-covered Prosthetic Devices and Medicare-covered Medical Supplies with no coinsurance and no copay. Diabetic Equipment is covered with no coinsurance and no copay for diabetic supplies and diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have no copay, while Lab Services and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HealthSun MediMax (HMO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the HealthSun MediMax (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered under the HealthSun MediMax (HMO) plan, but the plan does not cover additional days beyond Medicare-covered stays or non-Medicare-covered stays. Prior authorization and a doctor referral are required.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $103 per month, as well as a Meal Benefit with no copay. 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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