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HealthSun VitalCare (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for HealthSun VitalCare (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on HealthSun VitalCare (HMO C-SNP) in 2026, please refer to our full plan details page.
HealthSun VitalCare (HMO C-SNP) is a HMO C-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 4.5 out of 5 stars in 2026.
It's important to know that HealthSun VitalCare (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
HealthSun VitalCare (HMO C-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 VitalCare (HMO C-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 VitalCare (HMO C-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. 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 $1900.00 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 VitalCare (HMO C-SNP) prescription drug plan features a $0 drug deductible, meaning your coverage begins immediately. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications for up to a three-month supply at preferred, standard, and standard mail-order pharmacies. Tier 6 supplemental drugs also feature no copay for a one-month supply. For brand name and specialty medications, a one-month supply of Tier 3 preferred brand drugs costs a $5 copay. Tier 4 non-preferred drugs require a $50 copay at preferred and standard mail pharmacies, which increases to a $55 copay at standard pharmacies. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply across all pharmacy types.
Additional Benefits
The HealthSun VitalCare (HMO C-SNP) plan offers comprehensive coverage with no copay and no coinsurance for many key services, including inpatient hospital stays, primary and specialist doctor visits, and preventive care. Members can also take advantage of routine dental, vision, and hearing benefits with no copays, featuring a $5,000 annual maximum for dental care and a $2,000 annual allowance for prescription hearing aids. For other healthcare needs, the plan keeps out-of-pocket costs manageable with a $75 copay for outpatient hospital services, a $90 copay for emergency room visits, and no copay for durable medical equipment. Additionally, the plan includes valuable extra benefits like unlimited transportation to approved health locations and a $70 monthly allowance for over-the-counter items.
Inpatient Hospital See details
HealthSun VitalCare (HMO C-SNP) covers inpatient hospital acute and psychiatric stays with no copay and no coinsurance, although prior authorization and referrals are required. This benefit is partially covered, as additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
HealthSun VitalCare (HMO C-SNP) outpatient services are covered with no coinsurance, requiring a $75 copay for outpatient hospital and observation services. Ambulatory surgical center, outpatient substance abuse, and outpatient blood services are fully covered with no copay and no deductible.
Partial Hospitalization See details
HealthSun VitalCare (HMO C-SNP) covers partial hospitalization with no copay and no coinsurance. Prior authorization and a referral are required to receive these services.
Ambulance and Transportation Services See details
HealthSun VitalCare (HMO C-SNP) covers ground ambulance services with a $150 copay and no coinsurance, and air ambulance services with no copay and a 20% coinsurance. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay and no coinsurance, while trips to non-approved health-related locations are not covered.
Emergency Services See details
HealthSun VitalCare (HMO C-SNP) covers emergency services with a $90 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are available with no copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 maximum limit with a $90 copay and no coinsurance.
Primary Care See details
HealthSun VitalCare (HMO C-SNP) offers primary care, specialist, psychiatric, and telehealth services with no copay and no coinsurance, though chiropractic services are not covered. Occupational, physical, and speech therapy services are covered with no coinsurance and copays ranging from $0 to $15.
Preventive Services See details
HealthSun VitalCare (HMO C-SNP) partially covers preventive services with no copay and no coinsurance for all covered options, though prior authorization and referrals may be required. Non-covered services include annual physical exams, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, and counseling.
Hearing Services See details
HealthSun VitalCare (HMO C-SNP) partially covers hearing services with no copay and no coinsurance for Medicare-covered exams, annual routine exams, and hearing aid fittings. Prescription hearing aids are covered up to $2,000 annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by HealthSun VitalCare (HMO C-SNP), offering routine eye exams and eyewear with no copay and no coinsurance. Covered benefits include one routine eye exam per year and a $300 annual maximum for eyewear like contacts and eyeglasses, while other eye exams and eyewear upgrades are not covered.
Dental Services See details
HealthSun VitalCare (HMO C-SNP) offers partially covered dental services with no copay and no coinsurance up to a maximum annual plan benefit of $5,000. Covered benefits include preventive and comprehensive care, while other diagnostic, other preventive, maxillofacial prosthetics, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
HealthSun VitalCare (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs have a $0 to $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis services are covered by HealthSun VitalCare (HMO C-SNP) with no copay and a 20% coinsurance. Both prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical equipment is covered by HealthSun VitalCare (HMO C-SNP) with no copays and no coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Prior authorization is required for these benefits, and certain items may be limited to preferred vendors or specified manufacturers.
Diagnostic and Radiological Services See details
HealthSun VitalCare (HMO C-SNP) covers diagnostic and radiological services with no coinsurance, though prior authorization and referrals are required. Lab and outpatient X-ray services feature no copay, while diagnostic procedures and tests have copays ranging from $0 to $75, and other radiological services have copays starting at $0.
Home Health Services See details
Home Health Services are covered by HealthSun VitalCare (HMO C-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under HealthSun VitalCare (HMO C-SNP), as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered by the plan.
Skilled Nursing Facility (SNF) See details
HealthSun VitalCare (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, though prior authorization and referrals are required. There is no copay for days 1 through 20 and a $60 daily copay for days 21 through 100, but additional days beyond the standard Medicare limit are not covered.
Other Services See details
HealthSun VitalCare (HMO C-SNP) other services are partially covered, featuring no copay and no coinsurance for over-the-counter (OTC) items and chronic illness meal benefits, though acupuncture is not covered. Eligible members receive a $70 monthly allowance for OTC items including nicotine replacement therapy and naloxone.
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