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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 Palm Beach. 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. In the initial coverage phase, you'll pay a copay depending on the drug tier and pharmacy. For preferred generic drugs, there is no copay. Standard generic drugs have a $42-$47 copay, while preferred brand drugs have a $95-$100 copay. Non-preferred drugs have a 33% coinsurance, and specialty tier drugs have no copay.
Additional Benefits
The HealthSun HealthAdvantage Plus (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while many outpatient services, including primary care, preventive services, and dental services, are available with no copay. The plan covers emergency services, ambulance services, and home health services, with some services subject to copays or coinsurance. Additional benefits include hearing and vision services, home infusion, and medical equipment, all of which have some cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital coverage with the HealthSun HealthAdvantage Plus (HMO) plan includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and a doctor referral. For Inpatient Hospital-Acute, you'll pay a $150 copay for days 1-5, and no copay for days 6-90, while Inpatient Hospital Psychiatric has 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 with a $200 copay, observation services with no copay, ambulatory surgical center services with a $75 copay, outpatient substance abuse services with no copay for individual and group sessions, and outpatient blood services with no copay. Prior authorization and a doctor referral may be required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered under the HealthSun HealthAdvantage Plus (HMO) plan, with no copay. Prior authorization and a doctor's referral are required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the HealthSun HealthAdvantage Plus (HMO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services have a $25 copay; all have no coinsurance. Worldwide Emergency Services has a maximum plan benefit of $100,000.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with no copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $0-$15 copay, and Mental Health Specialty Services with no copay for both individual and group sessions. Podiatry Services and Other Health Care Professional services have no copay, while Physical Therapy and Speech-Language Pathology Services have a $0-$25 copay, and Additional Telehealth and Opioid Treatment Program Services have no copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, and additional preventive services, including health education, alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, remote access technologies, and kidney disease education services, all with no copay. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, home and bathroom safety devices and modifications, counseling services, and support for caregivers of enrollees are not covered. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, are covered with no copay.
Hearing Services See details
Hearing exams are covered with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids are covered, with a maximum plan benefit of $2000 every year, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams and eyewear have no copay. Eyewear has a combined maximum plan benefit coverage of $200 per year, and upgrades are not covered.
Dental Services See details
Dental Services are covered under the HealthSun HealthAdvantage Plus (HMO) plan, with no copay for Medicare Dental Services, Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery. Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a copay between $0 and $35. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the HealthSun HealthAdvantage Plus (HMO) plan, requiring prior authorization and a doctor referral. There is no copay for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 10% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 10% coinsurance, and Medical Supplies have a 10% coinsurance, and Diabetic Supplies have no copay. Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $200, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $200, Therapeutic Radiological Services with a copay up to $60, and Outpatient X-Ray Services with no copay. Prior authorization and a doctor referral are required.
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 coverage, but the plan does not cover any cardiac rehabilitation services.
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 referral. There is no copay for days 1-20, and a $60 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The HealthSun HealthAdvantage Plus (HMO) plan's "Other Services" benefit includes coverage for over-the-counter items with no copay, and a monthly maximum plan benefit of $59. 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 offers a meal benefit with no copay.
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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.
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