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AvMed Medicare Choice (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AvMed Medicare Choice (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AvMed Medicare Choice (HMO) in 2025, please refer to our full plan details page.
AvMed Medicare Choice (HMO) is a HMO plan offered by Sentara Health Care (SHC) available for enrollment in 2025 to people living in Miami-Dade County. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that AvMed Medicare Choice (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about AvMed Medicare Choice (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For AvMed Medicare Choice (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
Sign up for AvMed Medicare Choice (HMO)
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Drug Coverage
The AvMed Medicare Choice (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and a $15 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for covered drugs. However, you may still pay for excluded drugs covered under any enhanced benefit.
Additional Benefits
The AvMed Medicare Choice (HMO) plan offers coverage for a wide range of services. Inpatient hospital stays have a copay that varies based on the type of service and length of stay. Outpatient services, including primary care, have varying copays. This plan includes coverage for emergency and urgent care, with copays for each. Additional benefits include hearing and vision services, and dental coverage with copays. You will also have access to home health services with no copay, and skilled nursing facility services with a copay.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $75 copay for days 1-5, and no copay for days 6-90, while Additional Days have no copay. For Inpatient Hospital Psychiatric, you will pay a $150 copay for days 1-9, and no copay for days 10-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a $200 copay, observation services with a $175 copay, and ambulatory surgical center services with a $50 copay. Outpatient substance abuse services have a $15 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the AvMed Medicare Choice (HMO) plan, but requires prior authorization. The plan has a $15 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AvMed Medicare Choice (HMO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $165 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, with a limit of 8 trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Coverage, are covered by the AvMed Medicare Choice (HMO) plan. Emergency Services have a $100 copay, Urgent Services have a $10 copay, and Worldwide Emergency Coverage has a $100 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
AvMed Medicare Choice (HMO) covers primary care physician services with no copay, chiropractic services with a $5 copay, occupational therapy services with a $10 copay, specialist services with a $5 copay, and mental health services with a $15 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $20 copay, additional telehealth benefits have no copay, and opioid treatment program services have a $15 copay. Podiatry services have a $5 copay and routine foot care is covered.
Preventive Services See details
The AvMed Medicare Choice (HMO) plan covers preventive services, including an annual physical exam with no copay. Other preventive services, such as Health Education, Fitness Benefit, and Remote Access Technologies, may have a copay.
Hearing Services See details
Hearing Services include Hearing Exams with a $5 copay, Fitting/Evaluation for Hearing Aid with no copay, and Prescription Hearing Aids. Routine Hearing Exams, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision Services are covered, including routine eye exams and eyewear. Eye exams and eyewear have no copay. Contact lenses and eyeglasses (lenses and frames) are covered, with a combined maximum of $350 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery with copays ranging from $0 to $700. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with a $35 copay for Medicare Part B Insulin Drugs. Other Medicare Part B drugs have a coinsurance between 0% and 20%, and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the AvMed Medicare Choice (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits for AvMed Medicare Choice (HMO) include Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with no copay, and Medical Supplies with a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have no copay and a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The AvMed Medicare Choice (HMO) plan covers diagnostic and radiological services with some cost-sharing. Diagnostic Procedures/Tests have no copay, and Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $200 and a coinsurance of at most 20%, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the AvMed Medicare Choice (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the AvMed Medicare Choice (HMO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AvMed Medicare Choice (HMO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $160.
Other Services See details
The AvMed Medicare Choice (HMO) plan covers over-the-counter (OTC) items with no copay and a monthly maximum benefit of $25. Meal benefits are also covered with no copay and require prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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