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 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 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:
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Drug Coverage
The AvMed Medicare Circle (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying copays depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred pharmacies and $15 at standard pharmacies. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs.
Additional Benefits
The AvMed Medicare Circle (HMO) plan offers a range of benefits with varying costs. The plan includes coverage for inpatient hospital stays with a copay, outpatient services with copays, and ambulance services with a copay or coinsurance. It also covers primary care, preventive services, and various therapies, often with no copay. Additional benefits include coverage for hearing and vision services, with no copay for eye exams and eyewear, and a maximum benefit for hearing aids. Dental services are covered with copays, and the plan provides coverage for home infusion, dialysis, medical equipment, and diagnostic services with either copays or coinsurance. The plan also covers home health services and skilled nursing facility stays with a copay structure, and provides an over-the-counter item benefit.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $50 copay for days 1-5, and no copay for days 6-90, and no coinsurance. For Inpatient Hospital Psychiatric, you'll pay a $150 copay for days 1-9, and no copay for days 10-60, and no coinsurance. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services with the AvMed Medicare Circle (HMO) plan include outpatient hospital services with a $150 copay, observation services with a $100 copay, ambulatory surgical center services with a $75 copay, individual and group outpatient substance abuse sessions with a $15 copay, and outpatient blood services with no copay. Outpatient services require prior authorization.
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 service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AvMed Medicare Circle (HMO) plan, with prior authorization required for all ambulance services. 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, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage, are covered by the AvMed Medicare Circle (HMO) plan. Emergency Services have a $100 copay and no coinsurance, while Worldwide Emergency Coverage has a $100 copay and no coinsurance; however, Worldwide Emergency Transportation is not covered.
Primary Care See details
The AvMed Medicare Circle (HMO) plan covers primary care physician services, with no copay. Chiropractic services have a $5 copay, while occupational therapy services, physician specialist services, and additional telehealth benefits have no copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $15 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $20 copay. Podiatry services have a $5 copay for Medicare-covered and routine foot care.
Preventive Services See details
Preventive Services include an annual physical exam with no copay, and other services like health education, fitness benefits, and remote access technologies, some of which may have a copay. Additional services such as in-home safety assessments, and counseling services are not covered. Other preventive services like glaucoma screenings, diabetes self-management training, and digital rectal exams are covered with no copay.
Hearing Services See details
Hearing services include hearing exams and fitting/evaluation for hearing aids, with hearing exams covered at no copay. Prescription hearing aids have a maximum benefit coverage of $1500 every two years, and the plan covers two hearing aid visits every two years. Routine hearing exams, prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams and eyewear. Eye exams have no copay, and eyewear has no copay. Contact lenses and eyeglasses (lenses and frames) are covered, and the plan offers a combined maximum of $450.00 per year for eyewear, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The AvMed Medicare Circle (HMO) plan covers a range of dental services, including oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, implant services, prosthodontics (fixed), and oral and maxillofacial surgery, with copays ranging from $0 to $922. Orthodontic services and maxillofacial prosthetics are not covered by this plan.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AvMed Medicare Circle (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
The AvMed Medicare Circle (HMO) plan covers medical equipment, including Durable Medical Equipment (DME) with a 20% coinsurance, Prosthetic Devices with no copay, and Medical Supplies with a 20% coinsurance. The plan also covers Diabetic Equipment, with Diabetic Supplies having no coinsurance and Diabetic Therapeutic Shoes/Inserts with a 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, including all diagnostic services, diagnostic procedures/tests, lab services, and radiological services are covered. Diagnostic Procedures/Tests have a copay between $0 and $25, Diagnostic Radiological Services have a copay between $25 and $50, and Therapeutic Radiological Services have a 20% coinsurance. Outpatient X-Ray services have no copay.
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 the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the AvMed Medicare Circle (HMO) plan, but require prior authorization. For days 1-20, there is no copay; for days 21-62, the copay is $135, 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
The AvMed Medicare Circle (HMO) plan covers Over-the-Counter (OTC) items with no copay, and a monthly benefit maximum of $30.00. Other services like acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many more are not covered.
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