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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 2025, 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 5 out of 5 stars in 2025.
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 $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 $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) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay varying copays depending on the drug tier and pharmacy used. For example, preferred generic drugs and specialty tier drugs have no copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The HealthSun VitalCare (HMO C-SNP) plan offers a comprehensive range of benefits with a focus on outpatient and preventative care. This plan includes no copay for many services like primary care, hearing and vision exams, dental services, and home health, as well as many preventive services. You'll also find coverage for services like ambulance and transportation, emergency services, and skilled nursing facilities with varying copays. In addition to standard Medicare benefits, the plan offers extra coverage such as hearing aids up to $2000 per year, eyewear, and OTC items up to $55 per month. There are also no copays for services like outpatient substance abuse, and dialysis. However, some services like inpatient hospital stays, ambulance, and diagnostic services have copays, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric care, are covered by the HealthSun VitalCare (HMO C-SNP) plan, with no copay for Medicare-covered stays. Additional days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $50 copay, observation services with no copay, ambulatory surgical center services with no copay, outpatient substance abuse services with no copay, and outpatient blood services 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 VitalCare (HMO C-SNP), with prior authorization required for all ambulance services. Ground ambulance services have a $150 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have no copay, but transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by HealthSun VitalCare (HMO C-SNP). Emergency Services and Worldwide Emergency Coverage have a $90 copay, while Urgently Needed Services have no copay; all services have no coinsurance.
Primary Care See details
The HealthSun VitalCare (HMO C-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, and additional telehealth benefits have no copay. Occupational Therapy Services have a $15 copay, and Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $15.
Preventive Services See details
Preventive Services are covered, but annual physical exams are not. Medicare-covered preventive services, Health Education, Personal Emergency Response Systems, Alternative Therapies, Therapeutic Massage, Nutritional/Dietary Benefits, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit have no copay. Additional preventive services may have a copay.
Hearing Services See details
Hearing services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams and routine hearing exams have no copay, and fitting/evaluation for hearing aids has no copay, all available once per year. Prescription hearing aids are covered up to a maximum of $2000 per year, with no copay for all types of prescription hearing aids (all types) available twice per year. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The HealthSun VitalCare (HMO C-SNP) plan covers vision services, including routine eye exams and eyewear. Eye exams and eyewear have no copay, with a combined maximum of $300 per year for eyewear.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment with no copay, and other services are also covered with a $2,000 annual maximum. Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, and Oral and Maxillofacial Surgery are also covered with no copay, but Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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 by the HealthSun VitalCare (HMO C-SNP) plan, with no copay and no coinsurance. Prior authorization and a doctor referral are required.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered. Durable medical equipment has no copay or coinsurance, but requires prior authorization and has preferred vendors. Prosthetic devices, medical supplies, and diabetic supplies have no copay or coinsurance. Diabetic therapeutic shoes/inserts have no copay or coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, are covered with a copay ranging from $0 to $75; lab services have no copay, and diagnostic radiological services have a copay of at most $75.00. Therapeutic radiological services have a copay of at most $60.00, while outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the HealthSun VitalCare (HMO C-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization and a referral are required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, so there is no copay or coinsurance. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the HealthSun VitalCare (HMO C-SNP) plan. There is no copay for days 1-20, and a $60 copay for days 21-100.
Other Services See details
The HealthSun VitalCare (HMO C-SNP) plan covers Over-the-Counter (OTC) items with no copay, and a maximum plan benefit coverage amount of $55.00 per month, and also covers Meal Benefits with no copay. 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.
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