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HealthSun HealthAdvantage Plan (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSun HealthAdvantage Plan (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSun HealthAdvantage Plan (HMO) in 2026, please refer to our full plan details page.
HealthSun HealthAdvantage Plan (HMO) is a HMO plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Broward. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that HealthSun HealthAdvantage Plan (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 HealthAdvantage Plan (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 HealthAdvantage Plan (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 $50.00. 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 $2500.00 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:
Sign up for HealthSun HealthAdvantage Plan (HMO)
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Drug Coverage
The HealthSun HealthAdvantage Plan (HMO) offers budget-friendly prescription drug coverage starting with a $0 drug deductible, meaning your benefits kick in immediately. You will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs whether you use a preferred pharmacy, standard pharmacy, or standard mail order. This makes the plan highly cost-effective for individuals who rely primarily on generic and supplemental medications. For higher-tier medications, costs vary based on the drug tier and where you choose to fill your prescription. Tier 3 preferred brand drugs cost as little as a $5 copay at preferred pharmacies and standard mail order, or $20 at standard pharmacies. Tier 4 non-preferred drugs require a $75 or $80 copay, while Tier 5 specialty drugs require a 33% coinsurance across all pharmacy options.
Additional Benefits
The HealthSun HealthAdvantage Plan (HMO) features robust coverage with no copay or coinsurance for inpatient hospital stays, primary and specialist visits, and routine diagnostic tests. Outpatient services require low copays, such as $40 for hospital services and $20 for ambulatory surgical centers, while emergency care has a $150 copay that is waived upon admission. Additionally, the plan covers ground ambulance rides with a $200 copay and offers unlimited transportation to plan-approved locations with no copay. Members benefit from comprehensive dental, vision, and hearing coverage, including no copays for routine dental care up to a $5,000 annual limit, routine vision exams with up to $300 for eyewear, and prescription hearing aids up to a $2,000 yearly limit. The plan also features a monthly over-the-counter allowance of up to $82 and covers skilled nursing facility stays with no copay for the first 20 days. Standard durable medical equipment and dialysis require a 20% coinsurance, while diabetic supplies are available with no copay.
Inpatient Hospital See details
HealthSun HealthAdvantage Plan (HMO) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, though prior authorization and referrals are required. This benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSun HealthAdvantage Plan (HMO) covers outpatient hospital and observation services with a $40 copay and no coinsurance, and ambulatory surgical center services with a $20 copay and no coinsurance. Outpatient substance abuse and blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by the HealthSun HealthAdvantage Plan (HMO) with no copay and no coinsurance. This benefit requires both prior authorization and a referral.
Ambulance and Transportation Services See details
HealthSun HealthAdvantage Plan (HMO) covers ground ambulance services with a $200 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering unlimited one-way rides to plan-approved locations with no copay and no coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
HealthSun HealthAdvantage Plan (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum benefit with a $150 copay and no coinsurance per service.
Primary Care See details
HealthSun HealthAdvantage Plan (HMO) offers primary care, specialist, mental health, podiatry, and telehealth services with no copay and no coinsurance, while chiropractic services are not covered. Occupational therapy requires a $5 copay and physical or speech therapy ranges from no copay to a $5 copay, both with no coinsurance.
Preventive Services See details
Preventive Services are partially covered by the HealthSun HealthAdvantage Plan (HMO) with no copay and no coinsurance for covered benefits, though prior authorization or referrals may be required for certain services. Sub-services that are not covered include the Annual Physical Exam, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, 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, Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing services are partially covered by the HealthSun HealthAdvantage Plan (HMO), offering no copay, no coinsurance, and no deductible for annual routine exams, fitting evaluations, and prescription hearing aids up to a $2,000 yearly limit. However, OTC hearing aids and prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision Services are partially covered by the HealthSun HealthAdvantage Plan (HMO), offering one routine eye exam per year and eyewear with no copay, no coinsurance, and no deductible. Up to $300 per year is available for contacts, eyeglasses, frames, and lenses, although other eye exam services and eyewear upgrades are not covered.
Dental Services See details
HealthSun HealthAdvantage Plan (HMO) offers partially covered dental services with no copay and no coinsurance up to a maximum annual benefit of $5,000. Covered services include exams, cleanings, and restorative care, while other diagnostic, other preventive, maxillofacial prosthetics, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by the HealthSun HealthAdvantage Plan (HMO) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance. Medicare Part B insulin is also covered with a $0 to $35 copay and no coinsurance, with prior authorization required for home infusion services.
Dialysis Services See details
Dialysis Services are covered by the HealthSun HealthAdvantage Plan (HMO) with no copay and a 20% coinsurance, although prior authorization and referrals are required.
Medical Equipment See details
HealthSun HealthAdvantage Plan (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic services, with prior authorization required. Covered DME, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance and no copay, while diabetic supplies feature no copay.
Diagnostic and Radiological Services See details
HealthSun HealthAdvantage Plan (HMO) covers diagnostic and radiological services with no copays and no coinsurance, including diagnostic tests, lab services, therapeutic radiology, and X-rays. Prior authorization and referrals are required for these covered services.
Home Health Services See details
Home Health Services are covered under the HealthSun HealthAdvantage Plan (HMO) with no copay and no coinsurance, although prior authorization and a referral are required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the HealthSun HealthAdvantage Plan (HMO), as standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
HealthSun HealthAdvantage Plan (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $60 daily copay for days 21 through 100. Prior authorization and a referral are required for these services, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other Services under the HealthSun HealthAdvantage Plan (HMO) are partially covered, featuring a chronic illness meal benefit and a monthly over-the-counter benefit of up to $82, both with no copay and no coinsurance. Acupuncture and other additional services are not covered under this plan.
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