Sonder Heart Healthy (HMO C-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Sonder Health Plan Inc..
This page features plan details for 2023 Sonder Heart Healthy (HMO C-SNP) H1748 – 004 – 0 available in Cobb, DeKalb, Gwinnett, Fulton Counties.
Sonder Heart Healthy (HMO C-SNP) is offered in the following locations.
Sonder Heart Healthy (HMO C-SNP) offers the following coverage and cost-sharing.
| Special Needs Plan Type: | Chronic or Disabling Condition |
| Conditions Covered: |
| Insurer: | Sonder Health Plan Inc. |
| Health Plan Deductible: | $0.00 |
| MOOP: | $3,650 In-network |
| Drugs Covered: | Yes |
Ready to sign up for Sonder Heart Healthy (HMO C-SNP) ?
| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $164.90 | $0.00 | $0.00 | $0.00 | $164.90 |
Sonder Heart Healthy (HMO C-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $0.00 |
| Initial Coverage Limit: | $4,660.00 |
| Catastrophic Coverage Limit: | $7,400.00 |
| Drug Benefit Type: | Enhanced |
| Gap Coverage: | No |
| Formulary Link: | Formulary Link |
| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $0.00 | $43.40 | $34.80 | $26.30 | $17.70 |
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | |||
| 2 (Generic) | $15.00 copay | |||
| 3 (Preferred Brand) | $47.00 copay | |||
| 4 (Non-Preferred Drug) | $100.00 copay | |||
| 5 (Specialty Tier) | 33% | |||
| 6 (Select Care Drugs) | 0% |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | ||||
| 2 (Generic) | ||||
| 3 (Preferred Brand) | ||||
| 4 (Non-Preferred Drug) | ||||
| 5 (Specialty Tier) | ||||
| 6 (Select Care Drugs) |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|---|---|---|---|
| 1 (Preferred Generic) | $0.00 copay | $0.00 copay | ||
| 2 (Generic) | $45.00 copay | $45.00 copay | ||
| 3 (Preferred Brand) | $141.00 copay | $141.00 copay | ||
| 4 (Non-Preferred Drug) | $300.00 copay | $300.00 copay | ||
| 5 (Specialty Tier) | 33% | 33% | ||
| 6 (Select Care Drugs) | 0% | 0% |
After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | 25% |
| Brand-name drugs | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Drug Type | Cost Share |
|---|---|
| Generic drugs | $4.15 copay or 5% (whichever costs more) |
| Brand-name drugs | $10.35 copay or 5% (whichever costs more) |
Sonder Heart Healthy (HMO C-SNP) also provides the following benefits.
| In-Network: No |
| Diagnostic services: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Endodontics: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Extractions: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Non-routine services: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Periodontics: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Restorative services: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Cleaning: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Dental x-ray(s): | $0 copay (limits may apply) (authorization not required) (referral required) |
| Fluoride treatment: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Oral exam: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Diagnostic radiology services (e.g., MRI): | $0-275 copay (authorization required) (referral required) |
| Diagnostic tests and procedures: | $0 copay (authorization not required) (referral required) |
| Lab services: | $0 copay (authorization not required) (referral required) |
| Outpatient x-rays: | $0 copay (authorization required) (referral required) |
| Primary: | $0 copay |
| Specialist: | $0 copay (authorization not required) (referral required) |
| Emergency: | $120 copay per visit (always covered) |
| Urgent care: | $25 copay per visit (always covered) |
| Foot exams and treatment: | $40 copay (authorization not required) (referral required) |
| Routine foot care: | Not covered |
| $225 copay |
| $0.00 |
| In-Network: No |
| Fitting/evaluation: | Not covered (no limits) |
| Hearing aids: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Hearing exam: | $30 copay (authorization not required) (referral required) |
| $350 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
| $280 copay per visit (authorization required) (referral required) |
| $3,650 In-network |
| Diabetes supplies: | $0 copay (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | 20% coinsurance per item (authorization required) |
| Chemotherapy: | 20% coinsurance (authorization required) |
| Other Part B drugs: | 20% coinsurance (authorization required) |
| Inpatient hospital – psychiatric: | $350 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
| Outpatient group therapy visit: | $40 copay (authorization required) (referral required) |
| Outpatient group therapy visit with a psychiatrist: | $40 copay (authorization not required) (referral required) |
| Outpatient individual therapy visit: | $40 copay (authorization required) (referral required) |
| Outpatient individual therapy visit with a psychiatrist: | $40 copay (authorization not required) (referral required) |
| No |
| $0 copay (authorization not required) (referral required) |
| Occupational therapy visit: | $20 copay (authorization not required) (referral required) |
| Physical therapy and speech and language therapy visit: | $40 copay (authorization not required) (referral required) |
| $0 per day for days 1 through 20 $184 per day for days 21 through 100 (authorization required) (referral not required) |
| $0 copay (limits may apply) (authorization not required) (referral required) |
| Contact lenses: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Eyeglass frames: | Not covered (no limits) |
| Eyeglass lenses: | Not covered (no limits) |
| Eyeglasses (frames and lenses): | $0 copay (limits may apply) (authorization not required) (referral required) |
| Other: | Not covered (no limits) |
| Routine eye exam: | $0 copay (limits may apply) (authorization not required) (referral required) |
| Upgrades: | Not covered |
| Covered (authorization not required) (referral required) |
Ready to sign up for Sonder Heart Healthy (HMO C-SNP) ?
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
SMID: MULTIPLAN_HCIHNDOGMED01_M
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