A non-government entity
AvMed Medicare Circle (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AvMed Medicare Circle (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AvMed Medicare Circle (HMO) in 2025, please refer to our full plan details page.
AvMed Medicare Circle (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 Circle (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 Circle (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 Circle (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 $2500.00 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 Circle (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The AvMed Medicare Circle (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay varying copays depending on the drug tier and pharmacy used. For example, preferred generic drugs have no copay at preferred pharmacies, while standard generic drugs have a $47 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy, with no cost for Part D drugs if you have full LIS.
Additional Benefits
The AvMed Medicare Circle (HMO) plan offers comprehensive coverage with a variety of benefits. Inpatient hospital stays have a copay, with no copay for days 6-90. Outpatient services, emergency services, and specialist visits have copays, while primary care, preventive services, and many other services have no copay. This plan includes hearing, vision, and dental benefits, with varying copays for specific services like hearing aids and dental procedures. The plan also covers home health, cardiac rehabilitation, and skilled nursing facility stays, with some services having no copay and others having copays or coinsurance. Additionally, the plan offers OTC benefits and meal benefits, with a monthly allowance for OTC items.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For Inpatient Hospital-Acute, you will pay a $50 copay for days 1-5, and no copay for days 6-90. Inpatient Hospital Psychiatric has a $150 copay for days 1-9, and no copay for days 10-90. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, have a $150 copay. Ambulatory Surgical Center (ASC) services have a $50 copay, while outpatient blood services have no copay. Outpatient substance abuse services, including individual and group sessions, have a copay that ranges from $15.00 to $15.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the AvMed Medicare Circle (HMO) plan, but requires prior authorization. You will have a $15 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground ambulance services with a $145 copay, air ambulance services with 20% coinsurance, and transportation services with no copay. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the AvMed Medicare Circle (HMO) plan, with a $100 copay and no coinsurance, and the copay is waived if admitted to the hospital within 24 hours. Urgently Needed Services have no copay and no coinsurance, while Worldwide Emergency Coverage has a $100 copay and no coinsurance. Worldwide Urgent Coverage has no copay and no coinsurance, but Worldwide Emergency Transportation is not covered.
Primary Care See details
The AvMed Medicare Circle (HMO) plan offers primary care services with no copay, chiropractic services with a $5 copay, occupational therapy with no copay, and specialist services with no copay. The plan also covers mental health services with a $15 copay, podiatry services with a $5 copay, other health care professionals with a copay between $0 and $10, psychiatric services with a $15 copay, 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.
Preventive Services See details
Preventive Services include an annual physical exam, with no copay. Other services include health education, fitness benefits (memory fitness), and remote access technologies, all with no copay. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered, each with no copay. Other services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and more are not covered.
Hearing Services See details
Hearing services include hearing exams with no copay, and Fitting/Evaluation for Hearing Aid with no copay for one visit every year. Prescription hearing aids have a maximum benefit of $1500 per ear every two years, with coverage for Prescription Hearing Aids (all types) for two visits 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 are covered by the AvMed Medicare Circle (HMO) plan, including routine eye exams and eyewear. Routine eye exams, contact lenses, and eyeglasses have no copay, while eyeglass lenses, eyeglass frames, and upgrades are not covered. The plan covers one pair of contact lenses or eyeglasses per year, with a combined maximum of $450 per year for eyewear.
Dental Services See details
Dental services include coverage for oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery, with copays ranging from no copay to $922. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the AvMed Medicare Circle (HMO) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits with the AvMed Medicare Circle (HMO) plan include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with coinsurance and copay for Medicare-covered services, and Diabetic Equipment with varying coinsurance and copayments for specific services. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
AvMed Medicare Circle (HMO) covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $15, lab services with no copay, diagnostic radiological services with no copay, therapeutic radiological services with a coinsurance of up to 20%, and outpatient X-ray services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the AvMed Medicare Circle (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 covered, but no specific sub-services are covered. This means that you will not have to pay a copay or coinsurance for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the AvMed Medicare Circle (HMO) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-62 there is a $160 copay, and for days 63-100, there is no copay. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items and meal benefits with no copay, but 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. The plan offers up to $30 per month for OTC items.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved