2020 HealthSun MediMax (HMO) H5431-6-0 in FL from HealthSun Health Plans | HealthPocket

HealthSun MediMax (HMO)

$28/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderHealthSun Health Plans
Plan IDH5431-6-0
Plan Year2020
CMS Rating
Plan TypeHMO
Annual Deductible$435.00
Out-of-Pocket Maximum3400

What To Know About This Plan
  • This plan has health and drug coverage

Why We Like This Plan
  • has both Health and Drug Coverage
  • has been rated 5 stars by CMS

Overview

Premium
Total monthly premium$28.50
Health plan premium$0.00
Drug plan premium$28.50
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$0
Drug plan deductible$435.00
Estimated yearly costs
Estimated total yearly costs for care$3,360.00
Out-of-pocket max
Out-of-pocket max$3,400 In-network

Benefits & costs

Doctor services
Primary doctor visit$0 copay
Specialist visit$0 copay
Tests, labs, & imaging
Diagnostic tests & procedures$0 copay
Lab services$0 copay
Diagnostic radiology services (like MRI)$0 copay
Outpatient x-rays$0 copay
Emergency care$0 copay
Urgent care$0 copay
Hospital services
Inpatient hospital coverage$0 copay per stay
Outpatient hospital coverage$0 copay
Skilled nursing facility
Skilled nursing facility$0 copay per stay
Preventive services
Preventive services$0 copay
Ambulance
Ground ambulance$0 copay
Therapy services
Occupational therapy visit$0 copay
Physical therapy & speech & language therapy visit$0 copay
Mental health services
Outpatient group therapy with a psychiatrist$0 copay
Outpatient individual therapy with a psychiatrist$0 copay
Outpatient group therapy visit$0 copay
Outpatient individual therapy visit$0 copay
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)$0 copay
Prosthetics (like braces, artificial limbs)$0 copay
Diabetes supplies$0 copay

Extra benefits & costs

Hearing
Hearing exam$0 copay
Fitting/evaluation$0 copay
Hearing aids - All types$0 copay
Preventive dental
Oral exam$0 copay
Cleaning$0 copay
Fluoride treatment$0 copay
Dental x-rays$0 copay
Comprehensive dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative services$0 copay
EndodonticsNot covered
PeriodonticsNot covered
Extractions$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay
Vision
Routine eye exam$0 copay
Contact lenses$0 copay
Eyeglasses (frames & lenses)$0 copay
Eyeglass frames (only)$0 copay
Eyeglass lenses (only)$0 copay
UpgradesNot covered
More benefits
Fitness benefitLimited coverage
Transportation services for non-emergency care: Any health-related locationsNot covered
Transportation services for non-emergency care: Plan-approved locationsLimited coverage
Over the counter drug benefitsLimited coverage
In-home support servicesNot covered
Routine chiropractic serviceLimited coverage
Home and bathroom safety devicesNot covered
Meals for short durationLimited coverage
Annual physical examsNot covered
TelehealthNot covered

Drug coverage & costs

Part B drugs
Chemotherapy drugs0-20%
Other Part B drugs0-20%

Coverage Area for HealthSun MediMax (HMO)

StateFlorida
CountyMiami-Dade

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds25% coinsuranceNot offered25% coinsurance
Tier 2: Non-Preferred GenericNot offereds25% coinsuranceNot offered25% coinsurance
Tier 3: Preferred Brand NameNot offereds25% coinsuranceNot offered25% coinsurance
Tier 4: Non-Preferred Brand NameNot offereds25% coinsuranceNot offered25% coinsurance
Tier 5: Specialty TierNot offereds25% coinsuranceNot offered25% coinsurance
Tier 6: Select Care DrugsNot offereds$0 copayNot offered$0 copay

60 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds25% coinsuranceNot offered25% coinsurance
Tier 2: Non-Preferred GenericNot offereds25% coinsuranceNot offered25% coinsurance
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier
Tier 6: Select Care Drugs
90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred GenericNot offereds25% coinsuranceNot offered25% coinsurance
Tier 2: Non-Preferred GenericNot offereds25% coinsuranceNot offered25% coinsurance
Tier 3: Preferred Brand Name
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier
Tier 6: Select Care Drugs

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain assessmentNot Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Rheumatoid arthritis management
Reducing the risk of falling
Improving bladder controlNot Rated
Medication reconciliation post-discharge
Plan all-cause readmissions
Statin Therapy for Patients with Cardiovascular Disease

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Rating of health care quality
Rating of health plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY availability
Appeals auto-forward
Appeals upheldNot Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugsNot Rated

Drug Pricing and Patient Safety

MPF Price Accuracy
Medication adherence for diabetes medications
Medication adherence for hypertension - RAS antagonists
Medication adherence for cholesterol - Statins
MTM program completion rate for CMR
Statin use in persons with diabetes - SUPD

Physicians that accept HealthSun MediMax (HMO) for Florida

SOLIS SPF 001 (HMO)
COST:from $0CMS Rating:Not Rated
Select
CareOne PLUS (HMO)
COST:from $0CMS Rating:
Select
WellCare Dividend (HMO)
COST:from $0CMS Rating:
Select
BlueMedicare Classic Plus (HMO)
COST:from $0CMS Rating:
Select
Humana Gold Plus H1036-074 (HMO)
COST:from $0CMS Rating:
Select

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

Medicare Plans Found

 

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).