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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 2025, 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 5 out of 5 stars in 2025.
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.
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 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:
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Drug Coverage
The HealthSun HealthAdvantage Plan (HMO) has an "Enhanced Alternative" drug benefit type. This plan has no deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have no copay, while standard generic drugs have a $5 or $20 copay. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for covered drugs.
Additional Benefits
The HealthSun HealthAdvantage Plan (HMO) offers comprehensive coverage with a focus on low-cost services. Many services, including primary care, preventive services, outpatient substance abuse, and dental services have no copay. The plan also provides coverage for hearing, vision, and dental services, with specific allowances for hearing aids and eyewear. This plan also covers hospital stays, emergency services, and ambulance services. In addition, the plan includes benefits like home health services and medical equipment. Some services, such as skilled nursing facility stays, have a copay after the initial 20 days.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a doctor's referral and prior authorization. There is no copay for a Medicare-covered stay for both services, and the plan covers 3 additional days for Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades for both services are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $40 copay, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with a $20 copay, Outpatient Substance Abuse Services with no copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the HealthSun HealthAdvantage Plan (HMO) with no copay, but requires prior authorization and a doctor's referral.
Ambulance and Transportation Services See details
The HealthSun HealthAdvantage Plan (HMO) covers ambulance and transportation services, with prior authorization required. Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay, and other transportation services are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the HealthSun HealthAdvantage Plan (HMO), with a $90 copay for emergency services, worldwide emergency coverage, worldwide urgent coverage, and worldwide emergency transportation. Urgently Needed Services have no copay.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services, no copay for Chiropractic Services, and no copay for Physician Specialist Services. Occupational Therapy Services have a $5 copay, while Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $5. Individual and Group Sessions for Mental Health Specialty Services, Additional Telehealth Benefits, and Opioid Treatment Program Services have no copay. Podiatry Services and Other Health Care Professional benefits have no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered, with no copay for Medicare-covered services, and no copay for additional preventive services such as Health Education, Personal Emergency Response System (PERS), Alternative Therapies, Therapeutic Massage, Nutritional/Dietary Benefit, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual Physical Exams, In-Home Safety Assessments, 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, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams, routine hearing exams, and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a plan-specified amount of $2,000 per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The HealthSun HealthAdvantage Plan (HMO) covers vision services, including eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum plan benefit coverage of $300.00 every year. Upgrades are not covered.
Dental Services See details
Dental Services includes a $5,000 annual maximum, and covers oral exams, dental x-rays, cleaning, fluoride treatment, 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 by the HealthSun HealthAdvantage Plan (HMO). 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 HealthAdvantage Plan (HMO) and require prior authorization and a doctor's referral. There is no copay for these services.
Medical Equipment See details
The HealthSun HealthAdvantage Plan (HMO) covers medical equipment including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment. DME has a 10% coinsurance and no copay, while Prosthetic Devices and Medical Supplies have a 10% coinsurance, and Diabetic Supplies have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, lab services with no copay, diagnostic radiological services with no copay, therapeutic radiological services with no copay, and outpatient X-ray services with no copay. Prior authorization and a doctor referral are required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the HealthSun HealthAdvantage Plan (HMO) with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the HealthSun HealthAdvantage Plan (HMO) and require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $55 copay for days 21-100, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items and a Meal Benefit, both with no copay, but Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered. Over-the-Counter (OTC) Items have a maximum plan benefit coverage amount of $85.00 every month.
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