In-network
Inpatient hospital
Per admission $0 per stay
Plan-listed inpatient copay $0
● CMS 2026 plan record
HealthSun MediSun Extra (HMO D-SNP)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network$0 copay
Air · in-network$0 copay
Emergency services
Emergency room
$0 copay
Medical maximum
Maximum out-of-pocket
In-network$3,450
Combined in + outNot reported
Skilled care at home
Home health
In-network$0 copay
Out-of-networkNot separately reported
Monthly cost
Premium & giveback
Part C premium$0 / month
Consolidated C + D$0 / month
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Primary care physician
In: $0 copay · Out: Not separately reported
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Specialist
In: $0 copay · Out: Not separately reported
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Preventive care
In: $0 copay · Out: Not separately reported
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Diagnostic procedures & tests
In: $0 copay · Out: Not separately reported
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Laboratory services
In: $0 copay · Out: Not separately reported
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X-rays & standard imaging
In: $0 copay · Out: Not separately reported
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MRI, CT & PET imaging
In: $0 copay · Out: Not separately reported
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Urgent care
In: Cost share not reported · Out: Not separately reported
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Emergency room
In: $0 copay · Out: Not separately reported
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Ground ambulance
In: $0 copay · Out: Not separately reported
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Air ambulance
In: $0 copay · Out: Not separately reported
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Outpatient hospital
In: $0 copay · Out: Not separately reported
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Outpatient surgery / ASC
In: $0 copay · Out: Not separately reported
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Home health
In: $0 copay · Out: Not separately reported
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Skilled nursing facility
In: Cost share not reported · Out: Not separately reported
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Cardiac & pulmonary rehabilitation
In: $0 copay · Out: Not separately reported
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Occupational therapy
In: $0 copay · Out: Not separately reported
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Physical & speech therapy
In: $0 copay · Out: Not separately reported
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Mental health services
In: $0 copay · Out: Not separately reported
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Substance use treatment
In: $0 copay · Out: Not separately reported
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Podiatry
In: $0 copay · Out: Not separately reported
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Chiropractic
In: $0 copay · Out: Not separately reported
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Dental
In: $0 copay · Out: Not separately reported
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Vision
In: $0 copay · Out: Not separately reported
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Hearing
In: $0 copay · Out: Not separately reported
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Transportation
In: $0 copay · Out: Not separately reported
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Fitness & wellness
In: $0 copay · Out: Not separately reported
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Over-the-counter allowance
In: $0 copay · Out: Not separately reported
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Meals
In: $0 copay · Out: Not separately reported
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-network$0 copay
Out-of-networkNot separately reported
Specialist
In-network$0 copay
Out-of-networkNot separately reported
Preventive care
In-network$0 copay
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-network$0 copay
Out-of-networkNot separately reported
Laboratory services
In-network$0 copay
Out-of-networkNot separately reported
X-rays & standard imaging
In-network$0 copay
Out-of-networkNot separately reported
MRI, CT & PET imaging
In-network$0 copay
Out-of-networkNot separately reported
Urgent & hospital care6 benefits
Urgent care
In-networkCost share not reported
Out-of-networkNot separately reported
Emergency room
In-network$0 copay
Out-of-networkNot separately reported
Ground ambulance
In-network$0 copay
Out-of-networkNot separately reported
Air ambulance
In-network$0 copay
Out-of-networkNot separately reported
Outpatient hospital
In-network$0 copay
Out-of-networkNot separately reported
Outpatient surgery / ASC
In-network$0 copay
Out-of-networkNot separately reported
Recovery & therapy5 benefits
Home health
In-network$0 copay
Out-of-networkNot separately reported
Skilled nursing facility
In-networkCost share not reported
Out-of-networkNot separately reported
Cardiac & pulmonary rehabilitation
In-network$0 copay
Out-of-networkNot separately reported
Occupational therapy
In-network$0 copay
Out-of-networkNot separately reported
Physical & speech therapy
In-network$0 copay
Out-of-networkNot separately reported
Behavioral health2 benefits
Mental health services
In-network$0 copay
Out-of-networkNot separately reported
Substance use treatment
In-network$0 copay
Out-of-networkNot separately reported
Specialty care2 benefits
Podiatry
In-network$0 copay
Out-of-networkNot separately reported
Chiropractic
In-network$0 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits
Dental
In-network$0 copay
Out-of-networkNot separately reported
Vision
In-network$0 copay
Out-of-networkNot separately reported
Hearing
In-network$0 copay
Out-of-networkNot separately reported
Transportation
In-network$0 copay
Out-of-networkNot separately reported
Fitness & wellness
In-network$0 copay
Out-of-networkNot separately reported
Over-the-counter allowance
In-network$0 copay
Out-of-networkNot separately reported
Meals
In-network$0 copay
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview
Premium & Part B giveback
$0 Part C premium / month · Part B giveback not separately reported
Maximum out-of-pocket (MOOP)
In-network$3,450
Combined in + outNot reported
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Network & referrals
HMO · Referrals: Required for some services · Out-of-network coverage: No
Prescription drugs6 tiers
Part D deductible
Not reported
Drug tier 1
$0 retail copay · 30-day supply
Drug tier 2
$0 retail copay · 30-day supply
Drug tier 3
$10 retail copay · 30-day supply
Drug tier 4
$50 retail copay · 30-day supply
Drug tier 5
33% retail coinsurance · 30-day supply
Drug tier 6
$0 retail copay · 30-day supply
Using this plan
Understand H5431-019-000
Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.
Plan at a glance
A quick read on this plan
HealthSun MediSun Extra (HMO D-SNP) is a 2026 HMO offered by HealthSun Health Plans, Inc. in Broward, Miami-Dade. The CMS record does not indicate routine out-of-network coverage. Referrals are required for some services. Its listed inpatient copay stages total $0 across null charged days.
Common benefit costs
What you may pay
These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.
Routine care
- Primary care physician
- $0 copay
- Specialist
- $0 copay
- Laboratory services
- $0 copay
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- $0 copay
- MRI, CT & PET imaging
- $0 copay
- Outpatient hospital
- $0 copay
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $0 copay
- Listed inpatient stages
- $0 total
null charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.
Helpful context
Terms worth knowing
Maximum out-of-pocket (MOOP)
This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.
Availability
Who can enroll
- Service area
- Broward, Miami-Dade (FL)
- Plan type
- HMO
- Special Needs Plan
- Dual-Eligible
- Contract / plan
- H5431-019
- Coverage year
- 2026
This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area. Confirm eligibility and the exact service area with the plan before enrolling.
Supplemental coverage
Extra benefits reported
Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.
Dental$0 copay
Vision$0 copay
Hearing$0 copay
Over-the-counter allowance$0 copay
Fitness & wellness$0 copay
Transportation$0 copay
Meals$0 copay
Plan-specific answers
Frequently asked questions
Where is H5431-019-000 available?
HealthSun MediSun Extra (HMO D-SNP) is listed for Broward, Miami-Dade (FL). This is a Dual-Eligible; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.
What is the in-network maximum out-of-pocket limit for H5431-019-000?
The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $3,450. Prescription drug spending generally does not count toward this medical limit.
What is the monthly plan premium for H5431-019-000?
The listed consolidated Part C and Part D premium is $0 per month. This does not replace the standard Medicare Part B premium.
What does an emergency room visit cost on H5431-019-000?
The plan record lists $0 copay.
Does H5431-019-000 report extra benefits?
Yes. CMS reports dental, vision, hearing, over-the-counter allowance, fitness & wellness, and other supplemental benefits. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2026
Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.
Plan context
Where H5431-019-000 fits
- Full CMS plan ID
H5431-019-000- Contract
H5431- Base plan code
H5431-019- Segment
000- Carrier
- HealthSun Health Plans, Inc.
- Plan type
- HMO
- Service area
- Broward, Miami-Dade (FL)
County/service-area foundation
CMS service-area entries
Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.
- Broward, FL
- Miami-Dade, FL
- Miami-Dade, FL
About this code
What H5431-019-000 identifies
H5431-019-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H5431-019, H5431 019, or the compact full CMS ID H5431019000 refer to this plan or its base plan code.
Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.