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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 2026, 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 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.
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 $185.00. 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 $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:
Sign up for HealthSun HealthAdvantage Plus (HMO)
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Drug Coverage
The HealthSun HealthAdvantage Plus (HMO) Medicare plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs for up to a three-month supply at preferred, standard, or standard mail-order pharmacies. Additionally, Tier 6 supplemental drugs are available with no copay for a one-month supply. For brand-name and specialty medications, the plan offers competitive copays and coinsurance. Tier 3 preferred brand drugs require a $5 copay for a one-month supply, while Tier 4 non-preferred drugs have a $50 copay at preferred and standard mail-order pharmacies, and a $55 copay at standard pharmacies. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply across standard, preferred, and standard mail-order pharmacies.
Additional Benefits
The HealthSun HealthAdvantage Plus (HMO) plan offers comprehensive medical coverage with many essential services available with no copay and no coinsurance. Members enjoy no copay for primary care, telehealth, and mental health visits, while specialist visits carry a low copay of $0 to $15. For hospital care, inpatient stays require a $150 copay for the first five days followed by no copay, and outpatient hospital services carry a $200 copay. This plan also includes valuable supplemental benefits to help manage everyday health costs, often with no copay or coinsurance. Members receive dental coverage for exams, cleanings, and implants up to a $5,000 annual limit, a routine eye exam with a $200 eyewear allowance, and prescription hearing aid coverage up to $2,000. Additionally, the plan features a $103 monthly over-the-counter allowance and unlimited transportation to approved health locations with no copay.
Inpatient Hospital See details
Inpatient hospital care is covered by HealthSun HealthAdvantage Plus (HMO) with no coinsurance, requiring a $150 copay for days 1 to 5 of acute stays (with no copay for days 6 to 90) and no copay for psychiatric stays. Prior authorization and referrals are required, and the plan does not cover additional days, upgrades, or non-Medicare-covered stays.
Outpatient Services See details
HealthSun HealthAdvantage Plus (HMO) covers outpatient services with no coinsurance, featuring a $200 copay for outpatient hospital and observation services, and a $75 copay for ambulatory surgical center services. Outpatient substance abuse sessions and blood services are covered with no copay and no coinsurance, though prior authorization and referrals are required for most of these services.
Partial Hospitalization See details
Partial hospitalization is covered by HealthSun HealthAdvantage Plus (HMO) with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
HealthSun HealthAdvantage Plus (HMO) covers ground ambulance services with a $230 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Unlimited transportation to plan-approved health-related locations is covered with no copay and no coinsurance, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency services are covered by HealthSun HealthAdvantage Plus (HMO) with a $150 copay, and urgently needed services are covered with a $25 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $100,000 maximum limit with a $150 copay and no coinsurance.
Primary Care See details
HealthSun HealthAdvantage Plus (HMO) covers primary care, telehealth, mental health, podiatry, and psychiatric services with no copay and no coinsurance. Specialist visits require a $0 to $15 copay, physical and speech therapy range from $0 to $25, and occupational therapy has a $25 copay, all with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
HealthSun HealthAdvantage Plus (HMO) partially covers preventive services with no copay and no coinsurance, though prior authorization or referrals are required for certain benefits. Sub-services that are not covered under this plan include annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
HealthSun HealthAdvantage Plus (HMO) covers Medicare-covered and routine hearing exams, as well as fitting evaluations, with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $2,000 maximum annual benefit, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
HealthSun HealthAdvantage Plus (HMO) partially covers vision services with no copay, no coinsurance, and no deductible, which includes one routine eye exam per year and a $200 annual eyewear allowance. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
HealthSun HealthAdvantage Plus (HMO) offers partially covered dental services with no copay and no coinsurance up to an annual maximum benefit of $5,000. Covered services include exams, cleanings, and implants, while other diagnostic services, other preventive services, maxillofacial prosthetics, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by HealthSun HealthAdvantage Plus (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs carry no copay and a coinsurance of up to 20%, while Part B insulin is covered with a $0 to $35 copay and no coinsurance.
Dialysis Services See details
HealthSun HealthAdvantage Plus (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive this covered benefit.
Medical Equipment See details
HealthSun HealthAdvantage Plus (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic therapeutic shoes, with a 20% coinsurance and no copay. Diabetic supplies are covered with no copay, and prior authorization is required for most of these medical devices and equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by HealthSun HealthAdvantage Plus (HMO) with no coinsurance, though prior authorization and referrals are required. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests range from a $0 to $200 copay, and other radiological services have copays starting at $0.
Home Health Services See details
HealthSun HealthAdvantage Plus (HMO) covers home health services with no copay and no coinsurance, although a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by HealthSun HealthAdvantage Plus (HMO) with no coinsurance and a $5 copay, requiring prior authorization and a referral. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSun HealthAdvantage Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $60 copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
HealthSun HealthAdvantage Plus (HMO) provides coverage for select other services with no copay and no coinsurance, featuring a $103 monthly over-the-counter allowance and a meal benefit for chronic illnesses. Acupuncture and other additional services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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