2027 Medicare Advantage plan

Health First SunSaver H1099-016 (HMO): 2027 benefits and costs

Health First Health Plans, Inc. HMO

CMS plan ID: H1099-016-0 · Plan year: 2027

Health First SunSaver H1099-016 (HMO) is a 2027 Medicare Advantage plan offered by Health First Health Plans, Inc.. It is listed in Florida.

2027 plan costs at a glance

Monthly plan premium$0.00

Drug deductible$700.00

In-network medical out-of-pocket maximum$3,900.00

Organization: Health First Health Plans, Inc.
Plan organization: HEALTH FIRST HEALTH PLANS
Parent company: Health First Shared Services, Inc.
Plan type: HMO
Part C premium: $0.00
Part D premium: $0.00
Prescription drug coverage: Yes
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
In-network medical maximum: $3,900.00

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0.00 copay Service-specific deductible No
Specialist visit	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Telehealth	$0.00 to $25.00 copay Service-specific deductible No	Approval required No Referral required No
Emergency care	$150.00 copay
Urgent care	$25.00 copay
Home health	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No
Dialysis	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Medicare-covered foot care	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Other health professionals	$0.00 to $20.00 copay Service-specific deductible No	Approval required Yes Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–8: $200.00 copay per day Days 9–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–8: $200.00 copay per day Days 9–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $150.00 copay per day	Approval required Yes Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$0.00 to $200.00 copay Service-specific deductible No
Hospital observation services	$200.00 copay Service-specific deductible No
Ambulatory surgical center	$0.00 to $75.00 copay Service-specific deductible No	Approval required Yes Referral required No
Outpatient blood	$0 Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$50.00 copay Service-specific deductible No	Approval required Yes Referral required No
Laboratory services	$0.00 copay Service-specific deductible No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	$200.00 copay Service-specific deductible No	Approval required Yes Referral required No
Therapeutic radiology	20% coinsurance Service-specific deductible No	Approval required Yes Referral required No
X-rays	$50.00 copay Service-specific deductible No	Approval required Yes Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$15.00 copay Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	$15.00 copay Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, individual sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, group sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Opioid treatment program	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Mental health, individual sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Mental health, group sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, individual sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Psychiatry, group sessions	$20.00 copay Service-specific deductible No	Approval required Yes Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Physical and speech therapy	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Cardiac rehabilitation	$15.00 copay Service-specific deductible No	Approval required No Referral required No
Intensive cardiac rehabilitation	$15.00 copay Service-specific deductible No	Approval required No Referral required No
Pulmonary rehabilitation	$15.00 copay Service-specific deductible No	Approval required No Referral required No
Supervised exercise for peripheral artery disease	$10.00 copay Service-specific deductible No	Approval required No Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$260.00 copay Service-specific deductible No	Approval required Yes
Air ambulance	20% coinsurance Service-specific deductible No	Approval required Yes
Durable medical equipment	20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	10% coinsurance Service-specific deductible No	Approval required Yes
Diabetic monitors	0% to 20% coinsurance Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$30.00 copay
Oral examsAdditional plan benefit	$0
Dental X-raysAdditional plan benefit	$0
Other diagnostic dentalAdditional plan benefit	$0
Dental cleaningAdditional plan benefit	$0
FluorideAdditional plan benefit	$0
Other preventive dentalAdditional plan benefit	$0
Restorative dental careAdditional plan benefit	$0
Root canal treatment (endodontics)Additional plan benefit	$0
Gum treatment (periodontics)Additional plan benefit	$0
Removable dentures (prosthodontics)Additional plan benefit	$0
Maxillofacial prostheticsAdditional plan benefit	$0
Dental implantsAdditional plan benefit	$0
Fixed dental restorations (prosthodontics)Additional plan benefit	$0
Oral surgeryAdditional plan benefit	$0
OrthodonticsAdditional plan benefit	$0
Other dental servicesAdditional plan benefit	$0

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$15.00 copay Service-specific deductible No	Approval required Yes Referral required No
Routine eye examsAdditional plan benefit	$0.00 copay	Approval required Yes Referral required No
Medicare-covered eyewear	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglasses, lenses and framesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$35.00 copay Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0.00 copay	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$0.00 to $1,395.00 copay Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Limited-duration mealsAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Annual physical examAdditional plan benefit	$0.00 copay Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

Benefits for qualifying members

Diabetic Retinopathy Screening

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Diabetes
Covered package services cost $0 until the package limit is reached: No
Benefits that apply to reduced cost sharing: Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing: Eye exams (category)
Some package benefits are exempt from the deductible: No
Do you offer reduced Coinsurance?: No
Service-specific deductible: No
Reduced Copayment?: Yes
Types of benefits that apply to the copayment cost sharing: Medicare-covered benefits
Medicare-covered benefits that will receive reduced Copayment: Eye exams (category)
Minimum Copayment for Eye Exams: $0.00
Maximum Copayment for Eye Exams: $0.00

COPD Spirometry Test

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Chronic Obstructive Pulmonary Disease (COPD)
Covered package services cost $0 until the package limit is reached: No
Benefits that apply to reduced cost sharing: Medicare-covered benefits
Medicare benefits that apply to reduced cost sharing: Diagnostic Procedures/Tests
Some package benefits are exempt from the deductible: No
Do you offer reduced Coinsurance?: No
Service-specific deductible: No
Reduced Copayment?: Yes
Types of benefits that apply to the copayment cost sharing: Medicare-covered benefits
Medicare-covered benefits that will receive reduced Copayment: Diagnostic Procedures/Tests
Minimum Copayment for Diagnostic Procedures/Tests: $0.00
Maximum Copayment for Diagnostic Procedures/Tests: $0.00

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$5.00	$10.00	$15.00
Tier 3Preferred Brand	$42.00	$84.00	$126.00
Tier 4Non-Preferred Drug	30%	30%	30%
Tier 5Specialty Tier	25%	Not listed	Not listed

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	30 days	60 days	100 days
Tier 1Preferred Generic	$0.00	$0.00	$0.00
Tier 2Generic	$10.00	$20.00	$30.00
Tier 3Preferred Brand	$47.00	$94.00	$141.00
Tier 4Non-Preferred Drug	30%	30%	30%
Tier 5Specialty Tier	25%	Not listed	Not listed

Mail-order and other pharmacies

Out-of-network pricing: The standard retail copay or coinsurance applies, without an added difference between the billed charge and the plan’s allowed amount. The plan’s out-of-network coverage rules still apply.

Standard mail order costs

Standard mail order: initial-coverage cost per prescription fill
Drug tier	100 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$0.00
Tier 3Preferred Brand	$117.50
Tier 4Non-Preferred Drug	30%

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$10.00
Tier 3Preferred Brand	$47.00
Tier 4Non-Preferred Drug	30%
Tier 5Specialty Tier	25%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	30 days
Tier 1Preferred Generic	$0.00
Tier 2Generic	$10.00
Tier 3Preferred Brand	$47.00
Tier 4Non-Preferred Drug	30%
Tier 5Specialty Tier	25%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.