Medicare Advantage Plan Details

At Sunshine Health, we offer two Medicare Advantage Plans. Our Medicare insurance plans give you access to caring case managers, friendly, helpful member service representatives and a 24-hour nurse line for medical advice when you need it.

If you are eligible for Medicare, you may choose to enroll in our Medicare Advantage Plan with Prescription Drug coverage, also known as a MAPD plan. You can enroll online in our Sunshine Health Medicare Advantage (HMO) Plan.

If you are eligible for both Medicare and Medicaid, we have created a Medicare Advantage Plan with Prescription Drug coverage that combines the coverage under a single company to make it easier for you to manage. This special MAPD plan is known as a Dual Eligible Special Needs Plan, or D-SNP. You can enroll online in our Sunshine Health Medicare Advantage (HMO SNP) Plan if you qualify.

Plan Premium and Service Area Listing

The chart below shows some of your benefits available when you are a member of Sunshine Health Medicare Advantage.

Sunshine Health Medicare Advantage (HMO) CY2017

Plan Service Area Plan Premium Summary of Benefits Over the Counter (OTC) Drugs Brochure
Duval County $0 Not Available
Pasco, Pinellas, and Polk Counties       $0
Broward and Palm Beach Counties $0 Not Available
Miami-Dade County $0

Sunshine Health Medicare Advantage (HMO SNP) CY2017

Plan Service Area Plan Premium Summary of Benefits Over the Counter (OTC) Drugs Brochure
Baker, Duval, Hardee, Hernando, Manatee, Marion, Martin, Polk, and Volusia Counties $29.10*
Hillsborough, Pasco, Pinellas, St. Lucie, Lake, Orange, Osceola, and Seminole Counties $29.10*
Broward and Palm Beach Counties $29.10*
Miami-Dade County $29.10*

*Your monthly plan premium will vary from $0 to $29.10 based on your level of Extra Help. 

Extra Benefits for No Additional Premium

With our plans, you can get additional benefits for no additional premium. With Sunshine Health Medicare Advantage, you get dental services, vision services, hearing services, and a nurse advice line to answer your health questions. For more information on any of these additional benefits we provide, please call Sunshine Health at 1-844-293-2636  (HMO) or 1-877-935-8022 (HMO SNP) (TTY: 711).

Medicare's "Extra Help" Program

Medicare provides "Extra Help" to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you get help paying for any Medicare prescription drug plan's monthly premium, yearly deductible, and prescription co-payments. This Extra Help also counts toward your out-of-pocket costs.

Some people automatically qualify for Extra Help and don't need to apply. Medicare mails a letter to people who automatically qualify for Extra Help.

To see if you qualify for getting Extra Help:

  • Call 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048.  Get information 24 hours a day, 7 days a week. You can also visit www.medicare.gov to view a copy of the 'Medicare and You' handbook- see section 'Programs for People with Limited Income and Resources'; or
  • Call the Social Security Administration at 1-800-772-1213 between 7:00 a.m. and 7:00 p.m., Monday through Friday. TTY users call 1-800-325-0778; or
  • Call your State Medicaid Office

After you apply, you will get a letter letting you know if you qualify for Extra Help and what you need to do next.

Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.

Low Income Subsidy Premium Benefit

If you qualify for a Low Income Subsidy, you do not pay a separate monthly plan premium for our plans.  Some of our plans have a monthly premium of $29.10 per month.  If you are eligible for both Medicare and Extra Help, Medicare will pay this premium on your behalf.

You must continue to pay your Medicare Part B premium.  However, as a dual eligible, the state of Florida will cover your Part B premium as long as you retain your Medicaid eligibility.

For more detailed information on your benefits, please refer to your Summary of Benefits.


Last Updated: 02/20/2017
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