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HealthSun MediSun Extra (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSun MediSun Extra (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 Extra (HMO D-SNP) in 2025, please refer to our full plan details page.
HealthSun MediSun Extra (HMO D-SNP) is a HMO D-SNP plan offered by Elevance Health, Inc. available for enrollment in 2025 to people living in Broward, Miami-Dade. This plan received an overall rating of 5 out of 5 stars in 2025.
It's important to know that HealthSun MediSun Extra (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 Extra (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 Extra (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 Extra (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 Extra (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. In the initial coverage phase, you will pay a copay or coinsurance based on the drug tier and pharmacy type. After the deductible, you will pay $2 for preferred generic drugs, $25 for standard generic drugs, and 25% coinsurance for preferred brand and non-preferred drugs. Specialty tier drugs have no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The HealthSun MediSun Extra (HMO D-SNP) plan offers comprehensive coverage with no copays for many services. This includes inpatient and outpatient hospital services, ambulance and emergency services, primary care, preventive services, vision, dental, and home health services. The plan also covers hearing exams and hearing aids up to $2000 per year, and offers a monthly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage under the HealthSun MediSun Extra (HMO D-SNP) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both with no copay for a Medicare-covered stay. Additional days, non-Medicare-covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with no copay, but requires prior authorization and a doctor referral.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by HealthSun MediSun Extra (HMO D-SNP), including both ground and air ambulance services with no coinsurance, and a $0 copay for both. Transportation Services to a plan-approved health-related location are covered with no copay, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation all have no copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $100,000.
Primary Care See details
The HealthSun MediSun Extra (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Primary care physician services, chiropractic services, physician specialist services, individual and group mental health sessions, individual and group psychiatric sessions, physical therapy and speech-language pathology services, and additional telehealth benefits have no copay. Chiropractic services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, additional telehealth benefits, and opioid treatment program services require a referral and prior authorization. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are covered, but Annual Physical Exams are not covered. Medicare-covered preventive services, and additional preventive services, are covered with a doctor referral, and 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 (all types) are covered with a maximum plan benefit of $2000 per year, with no copay, while OTC hearing aids, prescription hearing aids - inner ear, prescription hearing aids - outer ear, and prescription hearing aids - over the ear are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. There is no copay for eye exams, routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses, and upgrades are not covered. Eyewear has a combined maximum plan benefit coverage amount of $400.00 every year.
Dental Services See details
The HealthSun MediSun Extra (HMO D-SNP) plan covers a range of dental services with a $5,000 annual maximum. 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 have no copay. Maxillofacial prosthetics, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 with prior authorization and a doctor referral. There is no copay for these services.
Medical Equipment See details
The HealthSun MediSun Extra (HMO D-SNP) plan covers Durable Medical Equipment (DME), Prosthetic Devices, Medical Supplies, and Diabetic Equipment. DME, Prosthetic Devices, and Diabetic Supplies have no copay, and Medical Supplies and Diabetic Therapeutic Shoes/Inserts have no coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services. There is no copay for Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services.
Home Health Services See details
Home Health Services are covered by the HealthSun MediSun Extra (HMO D-SNP) 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 covered, but the plan does not cover the specific services of 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. Prior authorization and a doctor's referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization and a doctor referral are required, and the plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C.
Other Services See details
The HealthSun MediSun Extra (HMO D-SNP) plan covers over-the-counter (OTC) items with no copay, and a maximum benefit coverage amount of $128.00 per month; however, 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 plan also covers a meal benefit with no copay.
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