HealthSun HealthAdvantage Plus (HMO)

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

It's important to know that HealthSun HealthAdvantage Plus (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 Plus (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 HealthAdvantage Plus (HMO) 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 and Tier 2 generic medications for up to a three-month supply at preferred, standard, and standard mail-order pharmacies. Additionally, Tier 6 supplemental drugs are covered with no copay for a one-month supply. For higher-tier medications, the plan requires a $5 copay for a one-month supply of Tier 3 preferred brand drugs. Tier 4 non-preferred drugs carry a $50 copay at preferred and standard mail-order pharmacies, or a $55 copay at standard retail pharmacies. Specialty drugs in Tier 5 require a 33% coinsurance for a one-month supply across all available pharmacy options.

Additional Benefits

The HealthSun HealthAdvantage Plus (HMO) plan offers robust medical coverage with minimal out-of-pocket costs, featuring no copays or coinsurance for inpatient hospital stays, primary care, specialist visits, and home health services. Outpatient services are highly affordable, with no copay for ambulatory surgery and a $75 copay for outpatient hospital services. Emergency care is available with a $120 copay, which is waived if you are admitted, while urgently needed services require no copay. This plan also provides excellent supplemental benefits, including no copays or coinsurance for routine dental care up to $5,000 annually, hearing services up to $2,000, and vision care up to $200. Additionally, members can take advantage of unlimited transportation to plan-approved locations and up to $95 per month for over-the-counter items with no copay. Durable medical equipment and diagnostic lab services are also covered with no copayments or coinsurance.