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 Palm Beach. 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 coverage begins immediately without any upfront out-of-pocket deductible costs. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs for a one, two, or three-month supply at preferred, standard, and standard mail-order pharmacies. Tier 6 supplemental drugs are also highly accessible, requiring no copay for a one-month supply. For higher-tier medications, the plan offers competitive copays and coinsurance for a one-month supply. Tier 3 preferred brand drugs have a low $5 copay, while Tier 4 non-preferred drugs cost a $50 copay at preferred or standard mail-order pharmacies and a $55 copay at standard pharmacies. Tier 5 specialty drugs require a 33% coinsurance at preferred, standard, and standard mail-order pharmacies.

Additional Benefits

The HealthSun HealthAdvantage Plus (HMO) plan offers robust medical coverage with many essential services requiring no copay and no coinsurance. For hospital care, inpatient acute stays require a $150 copay for days one through five and no copay for remaining days, while outpatient hospital services carry a $200 copay. Members also enjoy no copay for primary care, telehealth, and preventive services, while specialist visits require a copay of up to $15. Additional benefits include comprehensive dental, vision, and hearing care with no copay or coinsurance, featuring a $5,000 dental limit and a $200 eyewear allowance. The plan also provides a monthly allowance of up to $85 for over-the-counter items and unlimited transportation to approved locations with no copay. For specialized needs, durable medical equipment and dialysis require a 20% coinsurance, while standard home health services are fully covered with no copay.