2024 Medicare Advantage Plans

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Benefits you want. Plans you need.

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.

$0 Premiums on All Plans

$0 Copay on Your PCP Visits

$0 Copay on Specialist Visits

when you become a Sonder Diabetes Wellness member

24/7 Nurse Hotline Access

Vision, Hearing and Dental Benefits in Every Plan

Sonder Plan Details

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HMO – H1748001
Sonder Complete Health
Medicare Advantage

HMO – H1748001

Sonder Complete Health

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	$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 & Immunization	$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

C-SNP - H1748003
Sonder
Diabetes Wellness

HMO – H1748003

Sonder Diabetes Wellness

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 & Immunization	$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
Cardiovascular & Pulmonology Rehab	$0 (including Intensive Cardiac Rehab and SET for PAD)
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	$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

C-SNP - H1748004
Sonder
Heart Healthy

HMO – H1748004

Sonder Heart Healthy

For Cardiovascular Disorders (C-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	$25 Copay

Wellness and Preventative Care
Annual Wellness Exam	$0 Copay – 100% Coverage by Plan
Preventative Screenings & Immunization	$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
	$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

D-SNP – H1748005
Sonder
Dual Complete

HMO – H1748005

Sonder Dual Complete

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 & Immunization	$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
	$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
Over the Counter	$500 per Quarter
Transportation Allowance (per year)	$0 Copay for up to 50 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	$5,000

Vision Services *$0 Copay and $3,500 allowance if vision option is selected
Routine Eye	$0 Copay
Eyewear (Lenses, Frames, Contacts)	$500 Per Year Allowance

Hearing Services *$0 Copay and $3,000 allowance if hearing option is selected
Hearing Exams	$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
Sonder
HMO "My Choice" Plan

HMO – H1748010

Sonder Tiers Medicare Advantage

Medicare Advantage Plans with Part D Prescription Drug Coverage

Premium and Out of Pocket Limits
Monthly Plan Premium	$0 Copay
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 & Immunization	$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
	$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 Drug	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 Exams	$40 Copay

Additional Benefits
Meals Covered	14 Days (28 Meals Max)
Podiatry Services (Medicare Covered)	$40 Copay
Chiropractic Services	$15 Copay

HMO – H1748001
Sonder Complete Health Medicare Advantage
C-SNP - H1748003
Sonder Diabetes
Wellness
C-SNP - H1748004
Sonder
Heart Healthy
D-SNP – H1748005
Sonder
Dual Complete
HMO – H1748010
HMO "My Choice"
Plan