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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 Palm Beach. 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 $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) plan offers an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you'll pay a $0 copay for preferred generic drugs, and $37 or $42 for standard generic drugs depending on the pharmacy. Preferred brand drugs have an $85 or $90 copay, and non-preferred drugs have a 33% coinsurance. After your total drug costs reach $2000, 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 range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have a copay for some services. Emergency, urgent, and worldwide emergency services have a copay, and ambulance services have a copay or coinsurance. Preventive, primary care, hearing, vision, dental, and home health services have no copay. The plan also covers home infusion, dialysis, medical equipment, diagnostic, and radiological services with either no copay or a coinsurance. The plan also offers an Over-the-Counter (OTC) benefit and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization and a doctor's referral. For Inpatient Hospital-Acute, there is a $150 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, there is no copay. Additional days and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The HealthSun VitalCare (HMO C-SNP) plan covers outpatient hospital services with a $200 copay, observation services with no copay, ambulatory surgical center (ASC) services with a $75 copay, and outpatient substance abuse services with no copay. Outpatient blood services are also covered 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). Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location have 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 $90 copay, Urgently Needed Services has a $25 copay, and there is no coinsurance for any of these services.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the HealthSun VitalCare (HMO C-SNP) plan. Primary Care Physician Services, Chiropractic Services, and Additional Telehealth Benefits have no copay, while Occupational Therapy Services have a $25 copay. Physician Specialist Services have a copay between $0 and $15, and Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $25. Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, and Psychiatric Services have a $0 copay for individual and group sessions. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services are covered. Medicare-covered preventive services, including services not usually covered by Medicare, are covered with no copay. Annual physical exams, in-home safety assessments, counseling services, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, and home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, and telemonitoring services are not covered.
Hearing Services See details
The HealthSun VitalCare (HMO C-SNP) plan covers hearing exams and fitting/evaluation for hearing aids with no copay, and routine hearing exams with no copay for one visit per year. Prescription hearing aids are covered, with a maximum plan benefit of $2000 per year, and prescription hearing aids (all types) have no copay for two visits per year, but the plan does not cover prescription hearing aids for the inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear, with no copay for routine eye exams, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames; however, upgrades are not covered. Eyewear has a combined maximum benefit coverage of $300 per year.
Dental Services See details
Dental Services are covered, 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. The plan has a $2,000 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the HealthSun VitalCare (HMO C-SNP) plan. Medicare Part B Insulin Drugs have a copay between $0 and $35, and 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. There is no copay for Dialysis Services.
Medical Equipment See details
The HealthSun VitalCare (HMO C-SNP) plan covers Durable Medical Equipment (DME) with a 10% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 10% coinsurance and no copay, and Diabetic Equipment is covered with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic and radiological services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $200, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a copay up to $60, and 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but all of the sub-services are not covered. A doctor's referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization and a doctor referral. For days 1-20, there is no copay, and for days 21-100, the copay is $60.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit. Over-the-Counter (OTC) Items have no copay and a maximum benefit of $55 per month, and the plan offers Nicotine Replacement Therapy (NRT) and Naloxone coverage as a Part C OTC benefit. The Meal Benefit has no copay, and is for a chronic illness. 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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