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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 Broward 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 $3400.00 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:
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Drug Coverage
The AvMed Medicare Choice (HMO) plan has no deductible for prescription drugs. In the initial coverage phase, you will pay varying copays depending on the drug tier and the pharmacy you use. 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 pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The AvMed Medicare Choice (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll also find coverage for primary care, preventive services, vision, and dental services. This plan provides coverage for hearing aids with a maximum benefit, as well as ambulance and transportation services, with some services having no copay. Additionally, the plan covers home health services with no copay and offers coverage for medical equipment and diagnostic services, with copays and coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, there is a $65 copay for days 1-5 and no copay for days 6-90, and additional days have no copay; non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, there is a $150 copay for days 1-9 and no copay for days 10-90, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a $200 copay, observation services with a $200 copay, and ambulatory surgical center services with a $75 copay. Outpatient substance abuse services are covered, with individual and group sessions having a copay between $15 and $15, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the AvMed Medicare Choice (HMO) plan, but requires prior authorization. You will have a $15 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AvMed Medicare Choice (HMO) plan. Ground ambulance services have a $180 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered with no copay, up to 8 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by AvMed Medicare Choice (HMO), with a $100 copay for Emergency Services and Worldwide Emergency Coverage, and a $10 copay for Urgently Needed Services. Worldwide Urgent Coverage also has a $10 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The AvMed Medicare Choice (HMO) plan covers primary care physician services with no copay, chiropractic services with a $5 copay, occupational therapy with a $15 copay, physician specialist services with a $5 copay, mental health specialty services with a $15 copay for individual and group sessions, podiatry services with a $5 copay, other health care professional services with a copay between $0 and $10, psychiatric services with a $15 copay for individual and group sessions, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with no copay, and opioid treatment program services with a $15 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services. The annual physical exam has no copay, while additional preventive services may have a copay.
Hearing Services See details
Hearing Services include hearing exams with a $5 copay, fitting/evaluation for hearing aids, and prescription hearing aids (all types), which are covered with a maximum benefit of $1200 every two years. 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 include eye exams and eyewear. Eye exams have no copay, and include routine eye exams with no copay. Eyewear includes contact lenses and eyeglasses (lenses and frames) with no copay, and a combined maximum plan benefit coverage amount of $350.00 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The AvMed Medicare Choice (HMO) plan covers a variety of dental services with varying copays, including 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, prosthodontics, fixed, and oral and maxillofacial surgery. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AvMed Medicare Choice (HMO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with no copay. Medical supplies have a 20% coinsurance, and Diabetic Supplies have no copay. Diabetic Therapeutic Shoes/Inserts have 20% coinsurance and no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay between $5 and $25 for Diagnostic Procedures/Tests, and no copay for Lab Services. Therapeutic Radiological Services have a coinsurance of at least 20%, while Diagnostic Radiological Services have a copay between $75 and $100, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by AvMed Medicare Choice (HMO) 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. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $135. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under the AvMed Medicare Choice (HMO) plan, acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-Counter (OTC) Items are covered with no copay, and a meal benefit is covered with no copay.
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