Medicare Advantage Benefits (2014)

Florida Hospital SunSaver (HMO) and Florida Hospital Explorer (HMO-POS)

Florida Hospital is proud to offer Medicare Advantage plans so you can choose the benefits that are right for you. These plans include all of the benefits you'd get with Original Medicare, but also offer extra benefits and services that Original Medicare doesn't cover.

Medicare Advantage Prescription Drug (MA-PD) plans include both Medical (Part A and B) and Part D prescription drug benefits. Each plan offers different monthly plan premiums, cost shares, and coverage, so review the Summary of Benefits and other details carefully.

  • Service area: You must live in Volusia County or Flagler County in Florida to enroll in these plans.

Summary of Benefits

This booklet explains general information about our Florida Hospital SunSaver (HMO) and Florida Hospital Explorer (HMO-POS) options and compares them to original Medicare. It also includes information about premiums, cost sharing, out-of-network coverage and limitations.

 Florida Hospital Sunsaver (HMO) and Florida Hospital Explorer (HMO-POS) Summary of Benefits (Español)

Evidence of Coverage

These documents provide the most detailed information about each plan:

 Florida Hospital SunSaver (HMO) EOC

 Florida Hospital Explorer (HMO-POS) EOC


Health First Health Plans is an HMO plan with a Medicare contract. Enrollment in Health First Health Plans depends on contract renewal.

The benefit information provided is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Limitations, co-payments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/co-insurance may change on January 1 of each year.

Availability of coverage beyond the end of the current contract year is not guaranteed. Members may enroll in these plans only during certain times of the year. Contact Health First Health Plans for more information. Individuals must have both Medicare Part A and Part B to enroll in the plan. You must continue to pay your Medicare Part B premium. Limitations, copayments, and restrictions may apply.

You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances when you cannot reasonably use a network pharmacy. Quantity limitations and restrictions may apply.

Health First Medicare Advantage Plans cover emergency services and unforeseen urgently needed medical care outside the United States, including when you are on a cruise ship. If you receive covered care from a provider outside the United States that does not participate with Medicare, you may be asked to pay up front for the services and be reimbursed from the plan later. We will pay up to 115% of the Medicare-allowed amount in our service area (Medicare’s limiting charge for non-participating providers), less any applicable cost-share. Please note that Medicare-allowed amounts can be much less than the provider charges you, and you will be responsible for paying the difference.

This information is available for free in other languages. Please contact our Customer Service Department at 1-855-882-6467, or through TDD/TTY relay 1-800-955-8771 any day of the week from 8 am to 8 pm. Esta información está disponible de forma gratuita en otros idiomas. Comuníquese con nuestro Servicio al Cliente al 1-855-882-6467, TTY/TDD 1-800-955-8771 (lunes-domingo 8 am-8 pm).

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for getting Extra Help, call:

  • 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7days a week;
  • The Social Security Administration at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call 1-800-325-0778; or
  • Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.

You can also contact Social Security or Medicaid to find out your LIS status or level.

Unless your plan includes POS or Visitor/Travel program benefits, you must use plan providers except in emergency or urgent care situations, or for out-of-area renal dialysis. With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers. Health First Health Plans cannot require out-of-network providers to see our members. If your plan does not include POS or Visitor/Travel program benefits and you obtain routine care from out-of-network providers, neither Medicare nor Health First Health Plans will be responsible for the cost.

Medicare beneficiaries may enroll in Health First Medicare Plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.

More information

For more information on authorizations, eligibility, enrollment, pharmacies, prescriptions, or any other benefits, please contact Health First Health Plans Customer Service:

  • Call any day of the week from 8 am to 8 pm toll-free at 1-855-882-6467, or through TDD/TTY relay 1-800-955-8771.
  • Visit our main office in Volusia county weekdays from 8:30 am to 5 pm or write to us at 1425 W. Granada Blvd. Suite 4, Ormond Beach, FL 32174.

Y0089_MP3536FH Approved 11/06/2013
Last updated: 01/17/2014