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HealthSun HealthAdvantage Plus (HMO)

H5431 - 017 - 0
5 out of 5 stars (5 / 5)

HealthSun HealthAdvantage Plus (HMO) is a Medicare Advantage Plan by HealthSun Health Plans, Inc..

This page features plan details for 2025 HealthSun HealthAdvantage Plus (HMO) H5431 – 017 – 0 available in Miami-Dade.

Locations

HealthSun HealthAdvantage Plus (HMO) is offered in the following locations.

Florida
Miami-Dade County, Florida

Click to see more locations

Plan Overview

HealthSun HealthAdvantage Plus (HMO) offers the following coverage and cost-sharing.

Insurer:HealthSun Health Plans, Inc.
Health Plan Deductible:$0
MOOP:$3,450 In-network
Drugs Covered:Yes

Ready to sign up for HealthSun HealthAdvantage Plus (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans. 

HealthSun HealthAdvantage Plus (HMO) qualifies for a monthly Medicare Give Back Benefit of $174.70.

Premium Reduction:$174.70

Premium Breakdown

HealthSun HealthAdvantage Plus (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $174.70 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

HealthSun HealthAdvantage Plus (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $0.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

HealthSun HealthAdvantage Plus (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – 0.00 Copay (Limits Apply, Authorization Required)
  • Endodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Periodontics
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Prosthodontics, removable
    • In-Network: No Coins – 0.00 Copay (Authorization Required)
  • Restorative Services
    • In-Network: No Coins – 0.00 Copay (Authorization Required)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – 0.00 Copay
  • Fluoride Treatment
    • In-Network: No Coins – 0.00 Copay
  • Oral Exams
    • In-Network: No Coins – 0.00 Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – 0.00 Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic tests and procedures
    • $0-75 copay (Authorization Required, Referral Required)
  • Diagnostic radiology services (e.g., MRI)
    • $0-75 copay (Authorization Required, Referral Required)
  • Lab services
    • $0 copay (Authorization Required, Referral Required)
  • Outpatient x-rays
    • $0-75 copay (Authorization Required, Referral Required)

Doctor visits

  • Specialist
    • $0 copay (Authorization Required, Referral Required)
  • Primary
    • $0 copay

Emergency care/Urgent care

  • Urgent care
    • $0 copay
  • Emergency
    • $120 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • $0 copay (Limits Apply, Authorization Required)
  • Foot exams and treatment
    • $0 copay (Authorization Required)

Ground ambulance

    • $150 copay

Health plan deductible

    • $0

Hearing

  • Fitting/evaluation
    • $0 copay (Limits Apply)
  • Hearing aids
    • $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • $0 copay
  • Hearing aids OTC
    • Not covered

Inpatient hospital coverage

    • $0 copay per stay (Authorization Required, Referral Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $3,450 In-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • $0 copay (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • $0 copay (Authorization Required)
  • Diabetes supplies
    • $0 copay (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • 0-20% coinsurance (Authorization Required)
  • Other Part B drugs
    • 0-20% coinsurance (Authorization Required)

Mental health services

  • Outpatient individual therapy visit
    • $0 copay (Authorization Required, Referral Required)
  • Outpatient group therapy visit
    • $0 copay (Authorization Required, Referral Required)
  • Outpatient individual therapy visit with a psychiatrist
    • $0 copay (Authorization Required, Referral Required)
  • Inpatient hospital – psychiatric
    • $0 copay per stay (Authorization Required, Referral Required)
  • Outpatient group therapy visit with a psychiatrist
    • $0 copay (Authorization Required, Referral Required)

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • $75 copay per visit (Authorization Required, Referral Required)

Preventive care

    • $0 copay (Authorization Required, Referral Required)

Rehabilitation services

  • Occupational therapy visit
    • $15 copay (Authorization Required, Referral Required)
  • Physical therapy and speech and language therapy visit
    • $0-15 copay (Authorization Required, Referral Required)

Skilled Nursing Facility

    • $0 per day for days 1 through 20
      $60 per day for days 21 through 100 (Authorization Required, Referral Required)

Transportation

    • $0 copay (Authorization Required, Referral Required)

Vision

  • Eyeglass lenses
    • $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • $0 copay (Limits Apply)
  • Other
    • Not covered
  • Upgrades
    • Not covered
  • Contact lenses
    • $0 copay (Limits Apply)
  • Eyeglass frames
    • $0 copay (Limits Apply)
  • Routine eye exam
    • $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

    • Covered (Authorization Required, Referral Required)

Ready to sign up for HealthSun HealthAdvantage Plus (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Table of Contents

Get Help Enrolling

Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

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