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Medicare Advantage · C-SNP · HMO · 2027

HealthSun VitalCare (HMO C-SNP)

HealthSun Health Plans, Inc. H5431-0224.5 CMS rating for 2027
Is it offered where you live?

At a glance: $0 monthly premium, a Part B giveback of up to $202.90 a month, and $0 primary care visits.

Eligibility required for this C-SNP. The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. See who can enroll

Monthly premium
$0
Part B premium separate
Yearly limit
$2,450
Most you’d pay for in-network care
Part B giveback
Up to$202.90/mo
Up to $2,434.80 a year
Doctor visits
$0
Primary care · specialists $15

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Referral needed to see a specialist

Add your doctors and prescriptions to see how they work with this plan.

Your doctors
Not checked yetSee if they’re in this plan’s network
Your prescriptions
Not checked yetSee your drug tier and monthly cost
Extra benefits
8 includedPart B giveback · Dental · Hearing · OTC allowance · Vision · Fitness · Transportation · Meals

Talk to a licensed agent

Eligibility required for this C-SNP

The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.

Talk with a licensed advisor

A licensed agent can review this plan and other plans in your area that fit your needs.

TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST

Who can enroll

Eligibility for this Special Needs Plan

Eligibility required for this C-SNP

The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.

Extra benefits for members who qualify

  • Food and produce benefit
  • Meal benefit
  • General supports for living

These benefits are not available to every member. Even if you have a listed chronic condition, the plan must confirm that you meet its coverage criteria. See the Evidence of Coverage for complete rules.

Costs and copays

Deductibles, yearly limit, visits, hospital stays and drug tiers
DeductiblesMedical · $0 for drugs
$0
Yearly limitIn-network care, not counting drugs
$2,450
Primary doctorPer visit
$0
SpecialistPer visit · referral needed
$15
Hospital stayPer stay
Days 1-5: $150/day, Days 6-90: $0/day
Inpatient mental healthHospital stay
$0 copay
Outpatient surgeryPer procedure
$200
Emergency roomPer visit
$150
Urgent carePer visit
$25
Tier 1 · Preferred Generic30-day supply at a retail pharmacy
$0
Tier 2 · Generic30-day supply at a retail pharmacy
$0
Tier 3 · Preferred Brand30-day supply at a retail pharmacy
$37
Tier 4 · Non-Pref Brand30-day supply at a retail pharmacy
$85
Tier 5 · Specialty30-day supply at a retail pharmacy
33%
Tier 6 · Drugs30-day supply at a retail pharmacy
$0

Our take

Where this plan shines, and what to know

Where this plan shines

  • This plan has a $0 monthly premium.
  • This plan’s out-of-pocket maximum ($2,450) is among the lowest available.
  • See your primary doctor for $0.
  • The specialist copay ($15) is among the more affordable options.
  • No separate drug deductible.
  • No separate medical deductible.
  • Highly rated by CMS (4.5 stars).

Things to know before you enroll

  • You’ll need to use in-network providers except in emergencies.
  • Limited coverage while traveling outside the plan’s service area.

Similar plans

Other Medicare Advantage plans offered in Florida

Common questions

6 answers about this plan

What does HealthSun VitalCare (HMO C-SNP) cover?

HealthSun VitalCare (HMO C-SNP) is a Chronic Condition Special Needs Plan, a Medicare Advantage plan for people whose qualifying condition the plan verifies, including cardiovascular disorders and diabetes. The plan record also identifies Part D prescription drug coverage. Its published drug benefit lists 6 formulary tiers. Published supplemental benefits include dental ($5,000/yr preventive & comprehensive dental allowance), vision ($300/yr eyewear allowance), hearing ($2,000/yr hearing aid allowance), and over-the-counter (OTC) ($60/month OTC allowance). Review the plan documents for covered services, limits, and rules. Coverage can change each plan year.

Learn about Medicare Advantage

How much does HealthSun VitalCare (HMO C-SNP) cost in 2027?

The published 2027 monthly plan premium for HealthSun VitalCare (HMO C-SNP) is $0. Any Medicare premiums you owe are separate from the listed plan premium. The listed medical deductible is $0. The listed Part D deductible is $0. The in-network medical out-of-pocket maximum is $2,450; it does not include Part D drug spending. Published visit costs include primary care $0 and specialist visits $15. These figures are plan data, not a personal yearly-cost estimate.

Understand Medicare drug-cost limits

Can I use my current doctors with HealthSun VitalCare (HMO C-SNP)?

CMS lists HealthSun VitalCare (HMO C-SNP) as a HMO plan. The plan record says specialist referrals are required. A network label alone does not confirm that a specific doctor participates. Use the doctor lookup tool, then confirm with the doctor's office and the plan before receiving care. Provider networks and member costs can change. Emergency care and travel coverage can follow different network rules.

Check your doctors

What chronic conditions qualify for HealthSun VitalCare (HMO C-SNP)?

HealthSun VitalCare (HMO C-SNP) is listed in the current plan record as a C-SNP. The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.

Learn about Special Needs Plans

How does HealthSun VitalCare (HMO C-SNP) coordinate care for my chronic condition?

HealthSun VitalCare (HMO C-SNP) is identified in the current plan record as a Chronic Condition Special Needs Plan for qualifying conditions that include Cardio DIS CHF and Diabetes. The record also lists dental ($5,000/yr preventive & comprehensive dental allowance), vision ($300/yr eyewear allowance), and hearing ($2,000/yr hearing aid allowance). The data on this page does not describe a personal care plan or promise a specific care coordinator. Review the Evidence of Coverage and ask the plan how its model of care, provider communication, and medication support apply to your verified condition.

When can I enroll in HealthSun VitalCare (HMO C-SNP)?

HealthSun VitalCare (HMO C-SNP) is a 2027 Medicare Advantage plan. The Annual Enrollment Period runs from October 15 through December 7, with changes taking effect January 1. The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 for people already enrolled in Medicare Advantage. Because this is a C-SNP, the plan must also verify its eligibility requirements. A qualifying circumstance may create a Special Enrollment Period, but eligibility alone does not guarantee a year-round right to enroll. Confirm the enrollment window and effective date that apply to you before changing coverage.

Review Medicare enrollment periods

Plan documents

Summary of Benefits and Evidence of Coverage

Talk to a licensed agent

Eligibility required for this C-SNP

The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.

Talk with a licensed advisor

A licensed agent can review this plan and other plans in your area that fit your needs.

TTY: 711 · Monday to Friday, 8:00 AM to 6:00 PM CST

HealthSun VitalCare H5431-022 (HMO C-SNP) — 2027 Costs & Benefits