HealthSun HealthAdvantage Plus (HMO) 2025 Plan Details for Miami-Dade County, Florida Residents
HealthSun HealthAdvantage Plus (HMO) 2025 Plan Details for Miami-Dade County, Florida Residents
Choosing the right Medicare Advantage plan in Miami-Dade County is crucial for your healthcare needs in 2025. With HealthSun HealthAdvantage Plus (HMO) as one of the options, you can compare it side-by-side with other available plans to find the best fit for you. Whether you prefer enrolling online or seeking advice from a licensed agent, we’ve made the process simple and straightforward.
According to CMS enrollment data (May, 2025), there are approximately 5,273 members enrolled in this plan, 5,273 in Miami-Dade County.
HealthSun HealthAdvantage Plus Overview
| Plan ID H5431-017-0 Overview | |
|---|---|
| Health Plan ID: | H5431-017-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2025 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $3,450.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Miami-Dade County, FL |
| Insured By: | HealthSun Health Plans, Inc. |
Why Consider HealthSun HealthAdvantage Plus ?
With a monthly premium of $0.00, HealthSun HealthAdvantage Plus brings together hospital, medical, and prescription drug coverage in one coordinated Medicare Advantage HMO plan. It includes the core benefits of Medicare Part A and Part B, plus drug coverage to help manage your ongoing prescriptions. The annual Part D deductible is $0.00. As with most HMO plans, you’ll typically need to use in-network providers to keep costs predictable.
Primary care visits have a $0 copay, specialist visits come with a $0 copay, urgent care services carry a $0 copay, and ambulance transportation is $150 copay. These expenses count toward the plan’s maximum out-of-pocket (MOOP) limit of $3,450.00 . Once you reach that limit, your in-network care is covered at 100% for the rest of the year — a strong choice for anyone who wants bundled coverage and financial protection they can count on.
You’ll find this plan listed by CMS as H5431-017-0. You'll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
| We're Here to Help You Enroll |
|---|
Out-of-Pocket Expenses
HealthSun HealthAdvantage Plus has cost-sharing, meaning you'll have out-of-pocket costs when using approved healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5431-017-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | $0 Copay |
| Specialist: | $0 Copay Prior Authorization Required, Referral Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $120 Copay |
| Urgent care: | $0 Copay |
| Ground ambulance: | $150 Copay |
| Inpatient hospital care: | $0.00 per stay |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $60.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $0 Copay Prior Authorization Required |
| Routine Foot Care: | $0 Copay Prior Authorization Required |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $0 Copay Prior Authorization Required, Referral Required |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $0 Copay |
| Outpatient group therapy: | $0 Copay |
| Inpatient psychiatric hospital care: | $0.00 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $15 Copay Prior Authorization Required, Referral Required |
| Occupational therapy: | $15 Copay Prior Authorization Required, Referral Required |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | $0 Copay Prior Authorization Required |
| Prosthetics: | Not Covered |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $75 Copay Prior Authorization Required, Referral Required |
| Lab services: | $0 Copay Prior Authorization Required, Referral Required |
| Outpatient x-rays: | $75 Copay Prior Authorization Required, Referral Required |
| Diagnostic tests and procedures: | $75 Copay Prior Authorization Required, Referral Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | $0 Copay Prior Authorization Required |
| Oral exam | $0 Copay |
| Dental x-rays | $0 Copay |
| Cleaning | $0 Copay |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay |
| Hearing aids | Covered Limits may apply |
| Hearing exam | $0 Copay |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 Copay |
| Routine eye exam (in-network) | $0 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $200.00 Every year |
Certain preventive services are covered 100% by HealthSun HealthAdvantage Plus as a Part B benefit.
Part D Prescription Drug Costs & Benefits
HealthSun HealthAdvantage Plus includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $(59.60) |
|---|---|
| Supplemental Part D Premium: | $59.60 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before HealthSun Health Plans, Inc. starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, HealthSun HealthAdvantage Plus may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $0.00 |
| Generic | $0.00 | $0.00 |
| Preferred Brand | $10.00 | $10.00 |
| Non-Preferred Drug | $30.00 | $30.00 |
| Specialty Tier | 33.00% | 33.00% |
| Supplemental Drugs | $0.00 | $0.00 |
| *Deductible does not apply. | ||
Understanding CMS Star Ratings
Each year, the Centers for Medicare & Medicaid Services (CMS) assesses health plans (Part C) and drug plans (Part D) based on a 5-star rating system. These ratings provide an overview of the plan’s performance in areas such as preventive care, managing chronic conditions, and member experience.
Considering a plan’s star rating can be an important part of your decision-making process, as higher ratings often reflect stronger performance in key areas of healthcare and customer service.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Am I Eligible for HealthSun HealthAdvantage Plus ?
You are eligible to enroll in HealthSun HealthAdvantage Plus if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for HealthSun HealthAdvantage Plus and take advantage of its full range of benefits.
When Can I Enroll in HealthSun HealthAdvantage Plus ?
Knowing when you can enroll in HealthSun HealthAdvantage Plus is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
How to Sign Up for HealthSun HealthAdvantage Plus
Getting started with HealthSun HealthAdvantage Plus is simple. Here are your options:
- Online Enrollment: Easily enroll online using a secure form. Visit the MedicareEnrollment.com enrollment page and follow the steps to complete your enrollment.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent will guide you through the process and answer any questions.
- Through Medicare.gov: Enroll through the official Medicare website. Visit Medicare.gov, log in or create an account, and follow the instructions to join a Medicare Advantage plan.
- Directly with the Plan: You can also enroll directly with HealthSun HealthAdvantage Plus . The plan's contact information is available below in the "Contact" section.
Be sure to enroll during the appropriate period to ensure your coverage begins without delay.
Here are some of the most frequently asked questions people have about plan ID H5431-017-0:
Is there a premium for this plan in 2025?
The 2025 premium is $0.00 each month, and you must continue to pay your Part B premium.
How high can my costs go in a worst-case year?
Your costs top out at $3,450.00 (for in-network services) in 2025; after that the plan pays 100% of covered services.
Is there a Part D deductible with this plan?
The 2025 drug deductible is $0.00. The plan does not have a drug tier without a deductible.
What’s the CMS star score for HealthSun HealthAdvantage Plus ?
For 2025, plan H5431-017-0 has a ★5.0 rating. The best rating is 5 stars.
How many people are enrolled in this plan?
Enrollment stands at roughly 5,273 members.
Contact HealthSun Health Plans, Inc.
| Website: | HealthSun Health Plans, Inc. Plan Page |
|---|---|
| Providers: | HealthSun Health Plans, Inc. Providers Page |
| Formulary: | HealthSun Health Plans, Inc. Formulary Page |
| Pharmacy: | HealthSun Health Plans, Inc. Pharmacy Page |
| New Member Health Plan Help: | (833)668-2286 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (833)668-2292 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance — Last accessed October 15, 2024
- CMS.gov, Plan Benefits Package — Last accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed July 31, 2025
Learn more about how we use CMS data.
- HealthSun Health Plans, Inc., http://www.HealthSun.com — Last accessed June 1, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — Last accessed 25 May, 2025
Medicare.org is owned and operated by Health Network Group, LLC, an Allstate company. Medicare.org provides information only and is not connected with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content managed by David Bynon, Medicare Analyst.
Medicare Advantage and Part D plans and benefits offered by: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.