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HealthSun HealthAdvantage Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSun HealthAdvantage Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSun HealthAdvantage Plus (HMO) in 2025, please refer to our full plan details page.
HealthSun HealthAdvantage Plus (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 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.
For HealthSun HealthAdvantage Plus (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 $174.70. 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 $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 HealthAdvantage Plus (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, preferred generic drugs and specialty tier drugs have no copay, while standard generic drugs have a $5 copay. Preferred brand drugs have a $50 copay at preferred pharmacies and a $55 copay at standard pharmacies. Non-preferred drugs have a 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Part D covered drugs.
Additional Benefits
The HealthSun HealthAdvantage Plus (HMO) plan provides coverage for a wide range of services with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays ranging from $0-$200. Emergency services have a $120 copay, with urgently needed services at $25. Preventive, hearing, vision, and dental services are covered, with many services having no copay. The plan also includes coverage for ambulance, transportation, and home health services, with some services requiring copays or coinsurance. Additional benefits include medical equipment, diagnostic services, and a monthly OTC allowance, which may help you save money on healthcare expenses.
Inpatient Hospital See details
Inpatient Hospital coverage under the HealthSun HealthAdvantage Plus (HMO) plan includes a $150 copay for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric has no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $200 copay, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with a $75 copay, Outpatient Substance Abuse Services with no copay, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the HealthSun HealthAdvantage Plus (HMO) plan. There is no copay for this benefit, but prior authorization and a doctor referral are required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HealthSun HealthAdvantage Plus (HMO). Ground ambulance services have a copay of $230, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location have no copay, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including urgently needed services and worldwide emergency services, are covered. Emergency services have a $120 copay, while urgently needed services have a $25 copay; there is no coinsurance for any of these services. Worldwide emergency services have a maximum plan benefit coverage of $100,000.
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, with varying copays and prior authorization or referral requirements. Primary Care Physician Services, Chiropractic Services, and Additional Telehealth Benefits have no copay, while Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services have copays ranging from $0 to $25, and Physician Specialist Services have copays from $0 to $15. Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, and Opioid Treatment Program Services have no copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered services with no copay and additional services that may require a referral and prior authorization. The plan does not cover annual physical exams, but it does cover health education, alternative therapies, therapeutic massage, nutritional/dietary benefits, kidney disease education services, and other preventive services, all with no copay.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered with no copay. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum benefit of $200 per year, while upgrades are not covered.
Dental Services See details
The HealthSun HealthAdvantage Plus (HMO) plan offers dental services with a $2,000 annual maximum. Preventive services like oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments have no copay, but have visit limits. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, and Oral and Maxillofacial Surgery are covered with no copay, but also have visit limits. Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a copay of $0-$35 for Medicare Part B Insulin Drugs, and coinsurance between 0-20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered with prior authorization and a doctor's referral, and there is no copay.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment are covered. For durable medical equipment, there is a 10% coinsurance, and a $0 copay. Prosthetics have a 10% coinsurance, while medical supplies have a 10% coinsurance. Diabetic supplies have a $0 copay, and diabetic therapeutic shoes/inserts have a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the HealthSun HealthAdvantage Plus (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $200, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a copay up to $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the HealthSun HealthAdvantage Plus (HMO) plan 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 not covered by the HealthSun HealthAdvantage Plus (HMO) plan. 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 Plus (HMO) plan, but require prior authorization and a doctor's referral. There is no copay for days 1-20, and a $60 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefit, both with no copay, but 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. The OTC benefit has a maximum coverage amount of $55.00 per month.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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