We know what you need is unique to you. Sonder Health Plans offers four plans to fit your health and lifestyle.
Explore our plans to find the right fit for you! You can see more details about each plan on the Summary of Benefits.
HMO – H1748001
Medicare Advantage Part D Plan
| Premium and Out of Pocket Limits | |
|---|---|
| Annual Deductible | $0 |
| Max-Out-Of-Pocket (MOOP) | $3,200 |
| Provider Office Visits | |
|---|---|
| Primary Care Physician (PCP) Visit | $0 Copay |
| Specialist Visit | $0 Copay |
| Urgent Care | $30 Copay |
| Wellness and Preventative Care | |
|---|---|
| Annual Wellness Exam | $0 Copay – 100% Coverage by Plan |
| Preventative Screenings & Immunizations | $0 Copay – 100% Coverage by Plan |
| Silver and Fit Gym Benefit | $0 Copay – 100% Coverage by Plan |
| Surgical and Emergency Care | |
|---|---|
| Hospital Inpatient | $200 days 1-5;$0 days 6-90 |
| Hospital Outpatient | $250 Copay |
| Ambulatory Surgery Center (ASC) | $150 Copay |
| Ambulance (Ground) | $300 Copay |
| Emergency Room | $125 Copay |
| Skilled Nursing Facility | $0 days 1-20;$184 days 21-100 |
| Home Health | $0 Copay with Referral |
| Rehab/DME and Lab/Radiology | |
|---|---|
| Physical/Occupational/Speech Therapy | $25 Copay/$25 Copay/$25 Copay |
| Durable Medical Equipment | 20% Coinsurance |
| Diagnostic Radiology (ie. CT or MRI) | $150 for diagnostic imaging (e.g., sonagrams, ultrasounds) – $300 for advanced imaging (e.g., CT, MRI, PET) |
| Lab Services | $0 Copay |
| Outpatient X-Rays | $0-$100 Copay |
| Cardiovascular & Pulmonology Rehab | $20 Cardiac/Pulm/SET for PAD, $40 Intensive Cardiac Rehab |
| Diabetic Supplies | $0 Copay |
| Rx Drug Coverage – Elixer Rx Options | 1-Month/3-Month/Mail Order |
|---|---|
| Tier 1 Drugs – Preferred Generics | $0 Copay/$0 Copay/$0 Copay |
| Tier 2 – Non-Preferred Generics | $10 Copay/$30 Copay/$30 Copay |
| Tier 3 – Preferred Brands | $44 Copay/$132 Copay/$188 Copay |
| Tier 4 – Non-Preferred Brands | $95 Copay/$285 Copay/$285 Copay |
| Tier 5 – Specialty Drugs | 33% Coinsurance/33% Coinsurance/33% Coinsurance |
| Medicare Part B Drugs | 20% Coinsurance/20% Coinsurance/20% Coinsurance |
| Additional Services | |
|---|---|
| 24/7 Nurse Hotline | Yes |
| Over the Counter (OTC) Allowance (non-rolling) | $200 per Quarter |
| Transportation Allowance (per year) | $0 Copay for up to 50 One-Way Trips |
| Grocery Card | $55 Monthly Benefit |
| Comprehensive & Preventative Dental Services | |
|---|---|
| Exams | $0 Copay 1 every 6 months |
| Prophylaxis | $0 Copay 1 every 6 months |
| Fluoride | $0 Copay 1 every year |
| X-Rays | 1 every 2 years |
| Non-Routine Services | $0 Copay |
| Diagnostic Services | $0 Copay |
| Restorative Services | $0 Copay |
| Endodontics | $0 Copay |
| Periodontics | $0 Copay |
| Extractions | $0 Copay |
| Prosthodontics, Other Oral/Maxillofacial Surgery | $0 Copay |
| Combined Maximum Benefit | $1000 |
| Vision Services | |
|---|---|
| Routine Eye | $0 Copay |
| Eyewear (Lenses, Frames, Contacts) | $200 Per Year Allowance |
| Hearing Services from TruHearing | |
|---|---|
| Routine Hearing Exams | $0 Copay |
| Hearing Aids (Both Ears) | $699 or $999 copay per hearing aid, depeding on device |
| Additional Benefits | |
|---|---|
| Meals Covered | 14 Days (28 Meals Max) |
| Podiatry Services (Medicare Covered) | $25 Copay |
| Chiropractic Services | $20 Copay |
HMO – H1748003
For Diabetes Mellitus (C-SNP Plan)
| Premium and Out of Pocket Limits | |
|---|---|
| Annual Deductible | $0 |
| Max-Out-Of-Pocket (MOOP) | $3,850 |
| Provider Office Visits | |
|---|---|
| Primary Care Physician (PCP) Visit | $0 Copay |
| Specialist Visit | $0 Copay |
| Urgent Care | $25 Copay |
| Wellness and Preventative Care | |
|---|---|
| Annual Wellness Exam | $0 Copay – 100% Coverage by Plan |
| Preventative Screenings & Immunizations | $0 Copay – 100% Coverage by Plan |
| Silver and Fit Gym Benefit | $0 Copay – 100% Coverage by Plan |
| Surgical and Emergency Care | |
|---|---|
| Hospital Inpatient | $350/day (1-5); $0/day (6-90) |
| Hospital Outpatient | $280 Copay |
| Ambulatory Surgery Center (ASC) | $180 Copay |
| Ambulance (Ground) | $225 Copay |
| Emergency Room | $120 Copay |
| Skilled Nursing Facility | $0/day (1-20); $184/day (21-100) |
| Home Health | $10 Copay with Referral |
| Rehab/DME and Lab/Radiology | |
|---|---|
| Physical/Occupational/Speech Therapy | $40 Copay/$40 Copay/$40 Copay |
| Durable Medical Equipment | 20% Coinsurance |
| Diagnostic Radiology (ie. CT or MRI) | $0 for diagnostic imaging (e.g., sonagrams, ultrasounds) – $275 for advanced imaging (e.g., CT, MRI, PET) |
| Lab Services | $0 Copay |
| Outpatient X-Rays | $0 Copay |
| Diabetic Supplies | $0 Copay |
| Cardiovascular & Pulmonology Rehab | $0 (including Intensive Cardiac Rehab and SET for PAD) |
| Rx Drug Coverage – Elixer Rx Options | 1-Month/3-Month/Mail Order |
|---|---|
| Tier 1 Drugs – Preferred Generics | $0 Copay/$0 Copay/$0 Copay |
| Tier 2 – Non-Preferred Generics | $15 Copay/$45 Copay/$0 Copay |
| Tier 3 – Preferred Brands | $47 Copay/$141 Copay/$141 Copay |
| Tier 4 – Non-Preferred Brands | $100 Copay/$300 Copay/$300 Copay |
| Tier 5 – Specialty Drugs | 33% Coinsurance/33% Coinsurance/33% Coinsurance |
| Medicare Part B Drugs | 20% Coinsurance/20% Coinsurance/20% Coinsurance |
| Tier 6 – Select Care Drugs, including all Brand Name and Generic Insulin | $0 Copay |
| Additional Services | |
|---|---|
| 24/7 Nurse Hotline | Yes |
| Over the Counter (OTC) Allowance (non-rolling) | $125 per Quarter |
| Transportation Allowance (per year) | $0 Copay for up to 12 One-Way Trips |
| Grocery Card | $75 Monthly Benefit |
| Comprehensive & Preventative Dental Services | |
|---|---|
| Exams | $0 Copay 1 every 6 months |
| Prophylaxis | $0 Copay 1 every 6 months |
| Fluoride | $0 Copay 1 every year |
| X-Rays | 1 every 2 years |
| Non-Routine Services | $0 Copay |
| Diagnostic Services | $0 Copay |
| Restorative Services | $0 Copay |
| Endodontics | $0 Copay |
| Periodontics | $0 Copay |
| Extractions | $0 Copay |
| Prosthodontics, Other Oral/Maxillofacial Surgery | $0 Copay |
| Combined Maximum Benefit | $2000 |
| Vision Services | |
|---|---|
| Routine Eye | $0 Copay |
| Eyewear (Lenses, Frames, Contacts) | $200 Per Year Allowance |
| Hearing Services – Per Year | |
|---|---|
| Hearing Exams | $0 Copay |
| Hearing Aids | $699 or $999 copay per hearing aid, depeding on device |
| Additional Benefits | |
|---|---|
| Meals Covered | 14 Days (28 Meals Max) |
| Podiatry Services (Medicare Covered) | $0 Copay |
| Chiropractic Services | $20 Copay |
HMO – H1748004
| Premium and Out of Pocket Limits | |
|---|---|
| Monthly Plan Premium | $0 Copay |
| Annual Deductible | $0 |
| Max-Out-Of-Pocket (MOOP) | $3,850 |
| Provider Office Visits | |
|---|---|
| Primary Care Physician (PCP) Visit | $0 Copay |
| Specialist Visit | $0 Copay |
| Urgent Care | $25 Copay |
| Wellness and Preventative Care | |
|---|---|
| Annual Wellness Exam | $0 Copay – 100% Coverage by Plan |
| Preventative Screenings & Immunizations | $0 Copay – 100% Coverage by Plan |
| Silver and Fit Gym Benefit | $0 Copay – 100% Coverage by Plan |
| Surgical and Emergency Care | |
|---|---|
| Hospital Inpatient | $350/day (1-5); $0/day (6-90) |
| Hospital Outpatient | $280 Copay |
| Ambulatory Surgery Center (ASC) | $180 Copay |
| Ambulance (Ground) | $225 Copay |
| Emergency Room | $120 Copay |
| Skilled Nursing Facility | $0/day (1-20); $184/day (21-100) |
| Home Health | $10 Copay with Referral |
| Rehab/DME and Lab/Radiology | |
|---|---|
| Physical/Occupational/Speech Therapy | $40 Copay/$40 Copay/$40 Copay |
| Durable Medical Equipment | 20% Coinsurance |
| Diagnostic Radiology (ie. CT or MRI) | $0 for diagnostic imaging (e.g., sonagrams, ultrasounds) – $275 for advanced imaging (e.g., CT, MRI, PET) |
| Diabetic Supplies | $0 Copay |
| Lab Services | $0 Copay |
| Outpatient X-Rays | $0 Copay |
| Rx Drug Coverage – Elixer Rx Options | 1-Month/3-Month/Mail Order |
|---|---|
| Tier 1 Drugs – Preferred Generics | $0 Copay/$0 Copay/$0 Copay |
| Tier 2 – Non-Preferred Generics | $15 Copay/$45 Copay/$0 Copay |
| Tier 3 – Preferred Brands | $47 Copay/$141 Copay/$141 Copay |
| Tier 4 – Non-Preferred Brands | $100 Copay/$300 Copay/$300 Copay |
| Tier 5 – Specialty Drugs | 33% Coinsurance/33% Coinsurance/33% Coinsurance |
| Tier 6 – Select Care Drugs, including all Brand Name and Generic Insulin | $0 Copay |
| Medicare Part B Drugs | 20% Coinsurance/20% Coinsurance/20% Coinsurance |
| Additional Services | |
|---|---|
| 24/7 Nurse Hotline | Yes |
| Over the Counter (OTC) Allowance (non-rolling) | $125 per Quarter |
| Transportation Allowance (per year) | $0 Copay for up to 12 One-Way Trips |
| Grocery Card | $75 Monthly Benefit |
| Comprehensive & Preventative Dental Services | |
|---|---|
| Exams | $0 Copay 1 every 6 months |
| Prophylaxis | $0 Copay 1 every 6 months |
| Fluoride | $0 Copay 1 every year |
| X-Rays | 1 every 2 years |
| Non-Routine Services | $0 Copay |
| Diagnostic Services | $0 Copay |
| Restorative Services | $0 Copay |
| Endodontics | $0 Copay |
| Periodontics | $0 Copay |
| Extractions | $0 Copay |
| Prosthodontics, Other Oral/Maxillofacial Surgery | $0 Copay |
| Combined Maximum Benefit | $2000 |
| Vision Services | |
|---|---|
| Routine Eye | $0 Copay |
| Eyewear (Lenses, Frames, Contacts) | $200 Per Year Allowance |
| Hearing Services – Per Year | |
|---|---|
| Hearing Exams | $0 Copay |
| Hearing Aids | $699 or $999 copay per hearing aid, depeding on device |
| Additional Benefits | |
|---|---|
| Meals Covered | 14 Days (28 Meals Max) |
| Podiatry Services (Medicare Covered) | $40 Copay |
| Chiropractic Services | $20 Copay |
HMO – H1748005
For Dual-Eligible for Medicare/Medicaid Members (D-SNP Plan)
| Premium and Out of Pocket Limits | |
|---|---|
| Monthly Plan Premium | $0 Copay |
| Annual Deductible | $0 |
| Max-Out-Of-Pocket (MOOP) | $3,850 |
| Provider Office Visits | |
|---|---|
| Primary Care Physician (PCP) Visit | $0 Copay |
| Specialist Visit | $0 Copay |
| Urgent Care | $0 Copay |
| Wellness and Preventative Care | |
|---|---|
| Annual Wellness Exam | $0 Copay – 100% Coverage by Plan |
| Preventative Screenings & Immunizations | $0 Copay – 100% Coverage by Plan |
| Silver and Fit Gym Benefit | $0 Copay – 100% Coverage by Plan |
| Surgical and Emergency Care | |
|---|---|
| Hospital Inpatient | $0 Copay |
| Hospital Outpatient | $0 Copay |
| Ambulatory Surgery Center (ASC) | $0 Copay |
| Ambulance (Ground) | $0 Copay |
| Emergency Room | $0 Copay |
| Skilled Nursing Facility | $0 Copay |
| Home Health | $0 Copay |
| Rehab/DME and Lab/Radiology | |
|---|---|
| Physical/Occupational/Speech Therapy | $0 Copay/$0 Copay/$0 Copay |
| Durable Medical Equipment | $0 Copay |
| Diagnostic Radiology (ie. CT or MRI) | $0 Copay |
| Lab Services | $0 Copay |
| Outpatient X-Rays | $0 Copay |
| Cardiovascular & Pulmonology Rehab | $0 |
| Diabetic Supplies | $0 Copay |
| Rx Drug Coverage – Elixer Rx Options | 1-Month/3-Month/Mail Order |
|---|---|
| Tier 1 Drugs – Preferred Generics | $0 Copay/$0 Copay/$0 Copay |
| Tier 2 – Non-Preferred Generics | $0 Copay/$0 Copay/$0 Copay |
| Tier 3 – Preferred Brands | $0 Copay/$0 Copay/$0 Copay |
| Tier 4 – Non-Preferred Brands | $0 Copay/$0 Copay/$0 Copay |
| Tier 5 – Specialty Drugs | 0% Coinsurance/0% Coinsurance/0% Coinsurance |
| Additional Services | |
|---|---|
| 24/7 Nurse Hotline | Yes |
| Transportation Allowance (per year) | $0 Copay for up to 50 One-Way Trips |
| Over-The-Counter | $500 per quarter |
| Grocery Card | $75 Monthly Benefit |
| Comprehensive & Preventative Dental Services | |
|---|---|
| Exams | $0 Copay 1 every 6 months |
| Prophylaxis | $0 Copay 1 every 6 months |
| Fluoride | $0 Copay 1 every year |
| X-Rays | 1 every 2 years |
| Non-Routine Services | $0 Copay |
| Diagnostic Services | $0 Copay |
| Restorative Services | $0 Copay |
| Endodontics | $0 Copay |
| Periodontics | $0 Copay |
| Extractions | $0 Copay |
| Prosthodontics, Other Oral/Maxillofacial Surgery | $0 Copay |
| Combined Maximum Benefit | $5,000 |
| Vision Services | |
|---|---|
| Routine Eye | $0 Copay |
| Eyewear (Lenses, Frames, Contacts) | $500 Per Year Allowance |
| Hearing Services | |
|---|---|
| Hearing Exam | $0 Copay |
| Hearing Aids | $0 Copay |
| Additional Benefits | |
|---|---|
| Meals Covered | 14 Days (28 Meals Max) |
| Podiatry Services (Medicare Covered) | $0 Copay |
| Chiropractic Services | $0 Copay |
HMO – H1748010
Medicare Advantage Plans with Part D Prescription Drug Coverage
| Premium and Out of Pocket Limits | |
|---|---|
| Monthly Plan Premium | $0 |
| Annual Deductible | $0 |
| Max-Out-Of-Pocket (MOOP) | $6,700 |
| Provider Office Visits | |
|---|---|
| Primary Care Physician (PCP) Visit | $0 Copay |
| Specialist Visit | $0 Copay |
| Urgent Care | $30 Copay |
| Wellness and Preventative Care | |
|---|---|
| Annual Wellness Exam | $0 Copay – 100% Coverage by Plan |
| Preventative Screenings & Immunizations | $0 Copay – 100% Coverage by Plan |
| Silver and Fit Gym Benefit | $0 Copay – 100% Coverage by Plan |
| Surgical and Emergency Care | |
|---|---|
| Hospital Inpatient | $350/day (1-5); $0/day (6-90) |
| Hospital Outpatient | $250 Copay |
| Ambulatory Surgery Center (ASC) | $150 Copay |
| Ambulance (Ground) | $400 Copay |
| Emergency Room | $100 Copay |
| Skilled Nursing Facility | $0 days 1-20;$203 days 21-100 |
| Home Health | $0 Copay |
| Rehab/DME and Lab/Radiology | |
|---|---|
| Physical/Occupational/Speech Therapy | $25 Copay/$25 Copay/$25 Copay |
| Durable Medical Equipment | 20% Coinsurance |
| Diagnostic Radiology (ie. CT or MRI) | $150 for diagnostic imaging (e.g., sonagrams, ultrasounds) – $300 for advanced imaging (e.g., CT, MRI, PET) |
| Lab Services | $0 Copay |
| Outpatient X-Rays | $0 -$100 Copay |
| Cardiovascular & Pulmonology Rehab | $20 Cardiac/Pulm/SET for PAD, $40 Intensive Cardiac Rehab ($15 Pulm) |
| Diabetic Supplies | 20% Copay |
| Rx Drug Coverage – Elixer Rx Options | 1-Month/3-Month/Mail Order |
|---|---|
| Tier 1 Drugs – Preferred Generics | $0 Copay/$0 Copay/$0 Copay |
| Tier 2 – Non-Preferred Generics | $10 Copay/$30 Copay/$0 Copay |
| Tier 3 – Preferred Brands | $44 Copay/$132 Copay/$88 Copay |
| Tier 4 – Non-Preferred Brands | $95 Copay/$285 Copay/$285 Copay |
| Tier 5 – Specialty Drugs | 33% Coinsurance/33% Coinsurance/33% Coinsurance |
| Medicare Part B Drugs | 20% Coinsurance/20% Coinsurance/20% Coinsurance |
| Additional Services | |
|---|---|
| 24/7 Nurse Hotline | Yes |
| Over-The-Counter | $200 per quarter |
| Grocery Card | $400 Monthly Benefit |
| Comprehensive & Preventative Dental Services*$0 if dental option is selected | |
|---|---|
| Exams | $0 Copay 1 every 6 months |
| Prophylaxis | $0 Copay 1 every 6 months |
| Fluoride | $0 Copay 1 every year |
| X-Rays | 1 every 2 years |
| Non-Routine Services | $40 Copay* |
| Diagnostic Services | $40 Copay* |
| Restorative Services | $40 Copay* |
| Endodontics | $40 Copay* |
| Periodontics | $40 Copay* |
| Extractions | $40 Copay* |
| Prosthodontics, Other Oral/Maxillofacial Surgery | $40 Copay* |
| Combined Maximum Benefit | $4,000 (if selected) |
| Vision Services*$0 Copay and $3,500 allowance if vision option is selected | |
|---|---|
| Routine Eye | $0 Copay |
| Eyewear (Lenses, Frames, Contacts) | $40 Copay* |
| Hearing Services*$0 Copay and $3,000 allowance if hearing option is selected | |
|---|---|
| Hearing Exam | $40 Copay* |
| Additional Benefits | |
|---|---|
| Meals Covered | 14 Days (28 Meals Max) |
| Podiatry Services (Medicare Covered) | $40 Copay |
| Chiropractic Services | $15 Copay |
