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HealthSun MediSun Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSun MediSun Plus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSun MediSun Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
HealthSun MediSun Plus (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Palm Beach. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that HealthSun MediSun Plus (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HealthSun MediSun Plus (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about HealthSun MediSun Plus (HMO D-SNP).
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 MediSun Plus (HMO D-SNP), 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 MediSun Plus (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. In the initial coverage phase, the plan has no copay for preferred generic drugs at standard and mail order pharmacies, and a $1 copay for standard generic drugs at standard and mail order pharmacies. Preferred brand drugs have 20% coinsurance, while non-preferred drugs have 25% coinsurance. Specialty tier drugs have no copay at the standard and mail order pharmacies.
Additional Benefits
The HealthSun MediSun Plus (HMO D-SNP) plan offers comprehensive coverage with no copays for many services. This includes inpatient and outpatient hospital services, primary care, preventive services, hearing and vision exams, dental, dialysis, home health, and durable medical equipment. Prescription hearing aids are covered up to $2,000 per year, and eyewear has a combined maximum benefit of $400.00 every year. Additional benefits include no copay for ambulance and transportation services, emergency services, and various therapies. The plan also covers over-the-counter items and a meal benefit. Some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with no copay. Additional days, non-Medicare-covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. There is no copay for outpatient hospital services, observation services, ambulatory surgical center services, individual sessions for outpatient substance abuse, group sessions for outpatient substance abuse, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the HealthSun MediSun Plus (HMO D-SNP) plan with no copay. Prior authorization and a doctor referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Air and ground ambulance services have no coinsurance, but do have a copay. Transportation Services to a plan-approved health-related location are covered with no copay, while transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the HealthSun MediSun Plus (HMO D-SNP) plan. Emergency Services and Urgently Needed Services have no copay and no coinsurance, while Worldwide Emergency Services has a maximum plan benefit coverage of $100,000. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the HealthSun MediSun Plus (HMO D-SNP) plan. Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits have no copay. Chiropractic Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have a $0 copay.
Preventive Services See details
Preventive Services are covered, including services not usually covered by Medicare plans. Medicare-covered zero dollar preventive services, 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, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay. Annual physical exams, In-Home Safety Assessments, Medical Nutrition Therapy (MNT), 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 includes hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have no copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids (all types) have no copay and are covered up to $2,000 per year. 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 MediSun Plus (HMO D-SNP) plan covers vision services, including routine eye exams and eyewear. Routine eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $400.00 every year, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, implant services, and oral and maxillofacial surgery with no copay, but with visit limits and prior authorization required for some services, and a $5,000 annual maximum. Maxillofacial prosthetics, prosthodontics fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a copay between $0 and $35. 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 MediSun Plus (HMO D-SNP) plan, requiring prior authorization and a doctor's referral. There is no copay for dialysis services.
Medical Equipment See details
The HealthSun MediSun Plus (HMO D-SNP) plan covers Durable Medical Equipment (DME) with no coinsurance and no copay, but requires prior authorization. Prosthetic devices and medical supplies have no coinsurance and no copay. Diabetic equipment is covered, and includes 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. Lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the HealthSun MediSun Plus (HMO D-SNP) 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 MediSun Plus (HMO D-SNP) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the HealthSun MediSun Plus (HMO D-SNP) 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 and 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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