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Introduction to Medicare and HealthSun


If you have Medicare, you can join HealthSun today. When you are a member of HealthSun, we cover all your Medicare benefits from Part A and Part B services to Part D coverage. At HealthSun you'll receive coverage for your prescription drug costs covered under Medicare and other supplemental drugs selected by our plan. We also provide benefits for dental and hearing services, vision care, OTC items, transportation for your medical visits, gym membership, meal programs and other nutrition care programs, plus much more!  

Our service area includes Miami-Dade, Broward and Palm Beach Counties in Florida. You must live in one of these counties to join. Call today now to learn how you can switch and start living the good life at HealthSun!

Click here to find more information about the plans we offer.

What does it mean to be rated a Five (5) Star Plan?

A plan can get a rating from one to five stars. A 5-star rating is considered excellent.

What are the Medicare Star Ratings?

Medicare uses information from member satisfaction surveys, plans, and health care providers to give an over-all performance star rating to Medicare health and prescription drug plans.  The overall plan rating gives you a single summary score that makes it easy for you to compare plans based on quality and performance.  Our plan’s rating is measured on both the health and drug services that we cover. 

The overall score for quality of health services covers 36 different topics in 5 categories:

1.    Staying healthy
  Includes frequency of screening tests, vaccines, and other check-ups that keep members healthy.

2.    Managing chronic (long-term) conditions
  Includes frequency of tests and treatments for members with chronic conditions.

3.    Ratings of health plan responsiveness and care
  Includes ratings of member satisfaction with the plan.

4.    Health plan member complaints and appeals
  Includes how often members filed a complaint against the plan.

5.    Health plan telephone customer service
  Includes how well the plan handles calls from members.

The overall score for quality of drug services covers 17 different topics in the following 4 categories:

1.    Drug plan customer service
  Includes how well the drug plan handles calls and makes decisions about member appeals.

2.    Member experience with drug plan
  Includes member satisfaction information.

3.    Drug plan member complaints and Medicare audit findings
  Includes frequency of member complaints about the drug plan and findings from Medicare’s audit of the plan.

4.    Drug pricing and patient safety
  Includes how well the drug plan prices prescriptions and provides updated information on the Medicare website.

What is the 5-star Special Enrollment Period?

The 5-star Special Enrollment Period provides an opportunity for you to switch to a 5-star Medicare Advantage plan without or with prescription drug coverage, or a 5-star Medicare stand-alone Prescription Drug Plan. You may use this 5-star Special Enrollment Period one time between December 8 and November 30 of the next year, provided you meet the plan’s enrollment requirements (e.g., living within the service area, meeting requirements regarding end-stage renal disease, etc). People enrolled in a plan with a 5-star overall rating may also switch to different plan with a 5-star overall rating. Click here to learn how you can enroll in HealthSun.

Learn More About Plan Ratings

Visit the Medicare Plan Finder Tool on www.medicare.gov to learn more about plans and see their ratings. You can find a plan’s overall rating on the Plan Results page or view a complete summary of all plan’s quality and performance ratings by clicking “Plan Ratings” on the Plan Results page.

You have choices in your health care

HealthSun Health Plans is a Medicare Advantage Health Maintenance Organization (HMO). This website details some features of our plan. It does not list every service that we cover, every limitation, or every exclusion. To get a complete list of our benefits, you can always contact our Member Services Department at 305-447-4458 or Toll Free 1-877-336-2069.  TTY users should call 877-206-0500.

As a Medicare beneficiary, you can choose from different Medicare options. One option is Original Medicare (fee-for-service). Another option is a Medicare Advantage Plan, like HealthSun Health Plans (HMO). A Medicare Advantage Plan is a type of Medicare Health Plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. This type of health plan is an alternative to Original Medicare. You may have other options too. You make the choice. No matter what you decide, you are still in the Medicare Program.

Medicare Advantage plans can feature prescription drug benefits, have fixed costs, limits on out-of-pocket expenses, worldwide coverage for emergency and urgent care, and often provide additional benefits not found in Original Medicare. Including coverage for deductibles, steep reductions in coinsurance when you use doctors, a drug benefit plan and wellness or fitness programs.

You may join or leave a plan only at certain times. If you select a Medicare Advantage HMO, it replaces your Original Medicare coverage. However, you can return to Original Medicare down the road if you wish.  For additional information on Medicare click on their link: www.medicare.gov or call 1-800-Medicare (1-800-633-4227) for more information. TTY users should call 1-877-486-2048.

Can I choose my doctors?

HealthSun Health Plans has formed a network of doctors, specialists, and hospitals. You can choose doctors who are part of our network. The health providers in our network can change at any time. Contact our Member Services Department and ask for a current Provider Directory for an up-to-date list. Our number is listed at the end of this introduction. View more information about our Provider Network.

Where can I get my prescriptions if I join this plan?

HealthSun Health Plans has formed a network of pharmacies. You can use any pharmacy in our network. The pharmacies in our network can change at any time. Call us for a current Pharmacy Network List — our hours of operation and numbers are listed at the end of this page. View our Pharmacy Network.

Does my plan have a prescription drug formulary?

HealthSun Health Plans uses a formulary. A formulary is a preferred list of drugs selected to meet patient needs. The plan may periodically make changes to the formulary. If theformulary changes, affected enrollees will be notified in writing before the change is made. Contact HealthSun Health Plans for details.  Find more information about Prescription Drug Formularies.

What is a Medication Therapy Management (MTM) Program?

The MTM program is a service that our plan offers.You may be identified to participate in a program designed for your specific health and pharmacy needs. It is recommended that you take full advantage of this if you are selected. Contact HealthSun Health Plans for more details. Find a summary of our Medication Therapy Management (MTM) Program.

Additional Plan Information

Plan Star Rating

Multi-language Interpreter Services

Notice of Non-discrimination

Notice of Privacy Practices

Additional Questions?

Call HealthSun Health Plans at 305-447-4458 or toll free 1-877-336-2069. TTY users should call 1-877-206-0500.

For more information about Medicare, call 1-800-Medicare (1-800-633-4227). TTY users should call 1-877-486-2048. You can call 24 hours a day, 7 days a week. Or, visit www.medicare.gov on the web.