2020 Medicare Advantage Plan Services for
HealthSun HealthAdvantage Plan (HMO)
HealthSun HealthAdvantage Plan (HMO) H5431-013 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by HealthSun Health Plans, Inc. available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The HealthSun HealthAdvantage Plan (HMO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $3,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,400 out of pocket. This can be a extremely nice safety net.
HealthSun HealthAdvantage Plan (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
HealthSun Health Plans, Inc. works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for HealthSun HealthAdvantage Plan (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from HealthSun Health Plans, Inc. and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from HealthSun Health Plans, Inc. except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
2020 HealthSun Health Plans, Inc. Medicare Advantage Plan Details
HealthSun HealthAdvantage Plan (HMO)
|Provider:||HealthSun Health Plans, Inc.|
|Monthly Premium C+D:||$-|
|Part C Premium:||$0.00|
|Part D (Drug) Premium:||-$1.80|
|Part D Supplemental Premium||$1.80|
|Total Part D Premium:||$0.00|
|Tiers with No Deductible:||0|
|Benchmark:||not below the regional benchmark|
|Type of Medicare Health:||Enhanced Alternative|
|Drug Benefit Type:||Enhanced|
HealthSun Health Plans, Inc. plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
Part-D Deductible and Premium
HealthSun HealthAdvantage Plan (HMO) has a monthly drug premium of -$1.80 and a $0.00 drug deductible. This HealthSun Health Plans, Inc. plan offers a -$1.80 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $1.80 this Premium covers any enhanced plan benefits offered by HealthSun Health Plans, Inc. above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The HealthSun HealthAdvantage Plan (HMO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $0.00 for 75% low income subsidy $0.00 for 50% and $0.00 for 25%.
|Full LIS Premium:||$0.00|
|75% LIS Premium:||$0.00|
|50% LIS Premium:||$0.00|
|25% LIS Premium:||$0.00|
In 2020 once you and your plan provider have spent $4020 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This HealthSun Health Plans, Inc. plan does offer additional coverage through the gap.
HealthSun Health Plans, Inc. Drug Coverage and Formulary
A formulary is divided into tiers or levels of coverage based on the type or usage of your medication or benefit categories, according to drug costs. Each tier will have a defined out-of-pocket cost that you must pay before receiving the drug. You can see complete 2020 HealthSun HealthAdvantage Plan (HMO) H5431-013 Formulary here.
Ratings for HealthSun HealthAdvantage Plan (HMO) H5431
|2019 Overall Rating|
|Part C Summary Rating|
|Part D Summary Rating|
|Staying Healthy: Screenings, Tests, Vaccines|
|Managing Chronic (Long Term) Conditions|
|Member Experience with Health Plan|
|Complaints and Changes in Plans Performance|
|Health Plan Customer Service|
|Drug Plan Customer Service|
|Complaints and Changes in the Drug Plan|
|Member Experience with the Drug Plan|
|Drug Safety and Accuracy of Drug Pricing|
Staying Healthy, Screening, Testing, & Vaccines
|Total Preventative Rating|
|Breast Cancer Screening|
|Colorectal Cancer Screening|
|Annual Flu Vaccine|
|Improving Mental Health|
|Monitoring Physical Activity|
|Adult BMI Assessment|
Managing Chronic And Long Term Care for Older Adults
|SNP Care Management|
|Functional Status Assessment|
|Diabetes Care - Eye Exam|
|Diabetes Care - Kidney Disease|
|Diabetes Care - Blood Sugar|
|Reducing Risk of Falling|
|Improving Bladder Control|
|Plan All-Cause Readmissions|
Member Experience with Health Plan
|Total Experience Rating|
|Getting Needed Care|
|Timely Care and Appointments|
|Health Care Quality|
|Rating of Health Plan|
Member Complaints and Changes in HealthSun HealthAdvantage Plan (HMO) Plans Performance
|Complaints about Health Plan|
|Members Leaving the Plan|
|Health Plan Quality Improvement|
Health Plan Customer Service Rating for HealthSun HealthAdvantage Plan (HMO)
|Total Customer Service Rating|
|Timely Decisions About Appeals|
|Reviewing Appeals Decisions|
|Call Center, TTY, Foreign Language|
HealthSun HealthAdvantage Plan (HMO) Drug Plan Customer Service ratings
|Call Center, TTY, Foreign Language|
Ratings For Member Complaints and Changes in the Drug Plans Performance
|Complaints about the Drug Plan|
|Members Choosing to Leave the Plan|
|Drug Plan Quality Improvement|
Member Experience with the Drug Plan
|Rating of Drug Plan|
|Getting Needed Prescription Drugs|
Drug Safety and Accuracy of Drug Pricing
|MPF Price Accuracy|
|Drug Adherence for Diabetes Medications|
|Drug Adherence for Hypertension (RAS antagonists)|
|Drug Adherence for Cholesterol (Statins)|
|MTM Program Completion Rate for CMR|
|Statin with Diabetes|
Coverage Area for HealthSun HealthAdvantage Plan (HMO)
(Click county to compare all available Advantage plans)
Go to top
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.