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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 Palm Beach. 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 $2450.00 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) medicare plan features a $0 drug deductible, allowing your prescription drug coverage to begin immediately. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs across preferred pharmacies, standard pharmacies, and standard mail order services. For other medication tiers, a one-month supply of Tier 3 preferred brand drugs costs a $5 copay at preferred, standard, and standard mail order pharmacies. Tier 4 non-preferred drugs require a $50 copay at preferred pharmacies and standard mail order, or $55 at standard pharmacies, while Tier 5 specialty medications carry a 33% coinsurance.
Additional Benefits
The HealthSun VitalCare (HMO C-SNP) plan offers robust coverage with many essential services available with no copay and no coinsurance, including primary care, routine vision and hearing exams, home health, and preventive care. Members also benefit from generous supplemental allowances, including up to $5,000 annually for dental care, $300 for eyewear, $2,000 for prescription hearing aids, and a $65 monthly over-the-counter allowance. Unlimited transportation to plan-approved locations is also provided with no copay or coinsurance. For more intensive medical needs, acute inpatient hospital stays require a $150 copay for days 1 through 5, while skilled nursing facilities require a $60 daily copay for days 21 through 100. Emergency room visits carry a $150 copay, and outpatient hospital services have a $200 copay. Additionally, a 20% coinsurance applies to dialysis services, durable medical equipment, and air ambulance transportation.
Inpatient Hospital See details
HealthSun VitalCare (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, as upgrades, additional days, and non-Medicare-covered stays are not covered. Acute inpatient stays require a $150 copay for days 1 through 5 and no copay for days 6 through 90, while psychiatric inpatient stays have no copay.
Outpatient Services See details
HealthSun VitalCare (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $200 copay for outpatient hospital and observation services, and a $75 copay for ambulatory surgical center services. Outpatient substance abuse sessions and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
HealthSun VitalCare (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance. Both prior authorization and a referral are required for these covered services.
Ambulance and Transportation Services See details
HealthSun VitalCare (HMO C-SNP) covers ground ambulance services with a $250 copay and air ambulance services with a 20% coinsurance. Transportation services are partially covered, offering unlimited rides to plan-approved health-related locations with no copay or coinsurance, though transportation to other health-related locations is not covered.
Emergency Services See details
HealthSun VitalCare (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $100,000 lifetime maximum with a $150 copay and no coinsurance per service.
Primary Care See details
Primary care benefits are covered by HealthSun VitalCare (HMO C-SNP) with no coinsurance, including no copay for primary care, telehealth, mental health, and podiatry services. Specialist, occupational, and physical or speech therapy services require copayments from $0 to $25 with no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by HealthSun VitalCare (HMO C-SNP) with no copay and no coinsurance for all covered benefits, though some services require a referral or prior authorization. While benefits like kidney disease education and glaucoma screenings are covered, others such as the annual physical exam, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
HealthSun VitalCare (HMO C-SNP) covers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $2,000 annual limit for both ears combined, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
HealthSun VitalCare (HMO C-SNP) features partially covered vision services with no copay, no coinsurance, and no deductible, excluding other eye exam services and eyewear upgrades. Covered benefits include one routine eye exam per year and up to $300 annually for eyewear, including contact lenses, eyeglasses, lenses, and frames.
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 benefit of $5,000, although prior authorization is required for certain treatments. Covered benefits include preventive care, implants, and oral surgery, while other diagnostic services, other preventive services, 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 is required. Under this benefit, covered Medicare Part B chemotherapy, radiation, and other drugs require no copay with coinsurance ranging from no coinsurance up to 20%, while Part B insulin has no coinsurance and a copay of $0 to $35.
Dialysis Services See details
HealthSun VitalCare (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
HealthSun VitalCare (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with a 20% coinsurance and no copay, while diabetic equipment and shoes are covered with no copay and no coinsurance. Prior authorization is required for these benefits, and coverage 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, requiring prior authorization and referrals for all services. There is no copay for lab services and outpatient X-rays, while diagnostic procedures and tests have a copay ranging from $0 to $200, and other diagnostic and therapeutic radiological services have a minimum copay of $0.
Home Health Services See details
Home Health Services are covered by HealthSun VitalCare (HMO C-SNP) with no copay and no coinsurance, although prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by HealthSun VitalCare (HMO C-SNP) with no coinsurance, but require referrals and prior authorization. Although some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
HealthSun VitalCare (HMO C-SNP) covers skilled nursing facility services with no coinsurance, offering no copay for days 1 through 20 and a $60 daily copay for days 21 through 100. Prior authorization and referrals are required, and additional days beyond the Medicare-covered 100 days are not covered.
Other Services See details
HealthSun VitalCare (HMO C-SNP) partially covers other services, offering meals for chronic illnesses and a $65 monthly over-the-counter allowance with no copay and no coinsurance. Acupuncture and other additional services under this category are not covered.
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