2023 HealthSun HealthAdvantage Plus (HMO)

HealthSun HealthAdvantage Plus (HMO) H5431-018 is a 2023 Medicare Advantage Plan or Part-C by HealthSun Health Plans, Inc. available to residents in Florida. This plan includes additional prescription drug (Part-D) coverage. HealthSun Health Plans, Inc. HealthSun HealthAdvantage Plus (HMO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,450 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $3,450 out-of-pocket. This can be an extremely nice safety net.

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 Plus (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 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from HealthSun Health Plans, Inc. except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Florida.




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2023 HealthSun Health Plans, Inc. Medicare Advantage Plan Overview

Name:HealthSun HealthAdvantage Plus (HMO)
Plan ID:H5431 018 0
Provider:HealthSun Health Plans, Inc.
Year:2023
Type:Local HMO
Combined Premium (C+D):$0/mo
Part C Premium:$0/mo
MOOP:$3,450/yr
Part D (Drug) Premium:$0/mo
Part D Supplemental Premium$0/mo
Total Part D Premium:$0/mo
Drug Deductible:$0/yr
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:Not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H5431-020




What type of plan is HealthSun HealthAdvantage Plus (HMO)

HealthSun HealthAdvantage Plus (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 primary care physician 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 primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.



How much does HealthSun HealthAdvantage Plus (HMO) cost?


Monthly Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. HealthSun Health Plans, Inc. charges a $0 consolidated premium. The Part C premium is $0 this charge 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

An annual deductible is the amount you pay out-of-pocket for your prescription drugs before your plan begins to pay. HealthSun HealthAdvantage Plus (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This HealthSun Health Plans, Inc. plan offers a $0 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 $0. 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. The Part D Total Premium is the addition of supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.


HealthSun Health Plans, Inc. Gap Coverage

In 2023 once you and your plan provider have spent $4660 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.


MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. HealthSun HealthAdvantage Plus (HMO) by HealthSun Health Plans, Inc. MOOP is $3,450. Once you spend $3,450 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.



Formulary and Drug Coverage

HealthSun HealthAdvantage Plus (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $0 $0
Tier 2 $0 $0
Tier 3 $42 $47
Tier 4 $95 $100
Tier 5 33% 33%
Tier 6 $0 $0

The complete HealthSun HealthAdvantage Plus (HMO) Formulary.
*Initial Coverage Phase and 30 day supply





CMS Star Ratings


Is HealthSun HealthAdvantage Plus (HMO) a good plan? HealthSun HealthAdvantage Plus (HMO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare HealthSun HealthAdvantage Plus (HMO) performance among several different plans.

2022 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
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with H5431-018 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for HealthSun Health Plans, Inc.

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
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



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Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for HealthSun HealthAdvantage Plus (HMO) requires you to live in that plan’s service area. The service area is listed below:



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How much does HealthSun HealthAdvantage Plus (HMO) cost?

HealthSun Health Plans, Inc. charges a $0 consolidated monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage of Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is HealthSun HealthAdvantage Plus (HMO) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. HealthSun HealthAdvantage Plus (HMO) by HealthSun Health Plans, Inc. MOOP is $3,450. Once you spend $3,450 you will pay nothing for Part A or Part B covered services.

What type of plan is HealthSun HealthAdvantage Plus (HMO)?

HealthSun HealthAdvantage Plus (HMO) is a Local HMO. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).

Is HealthSun HealthAdvantage Plus (HMO) a good plan?

HealthSun HealthAdvantage Plus (HMO) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.



Source:CMS. Data as of Oct 1, 2022.

Last updated on

Notes: Data are subject to change as contracts are finalized. For 2023, 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 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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*Licensed Agent Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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