A non-government entity
AvMed Medicare Access (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AvMed Medicare Access (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AvMed Medicare Access (HMO-POS) in 2025, please refer to our full plan details page.
AvMed Medicare Access (HMO-POS) is a HMO-POS 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 Access (HMO-POS) 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 Access (HMO-POS).
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 Access (HMO-POS), 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:
Sign up for AvMed Medicare Access (HMO-POS)
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 Access (HMO-POS) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. In the initial coverage phase, you'll pay varying copays depending on the drug tier and pharmacy type, ranging from no copay to $100. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The AvMed Medicare Access (HMO-POS) plan offers a range of benefits with varying cost-sharing. It covers inpatient hospital stays with a copay, outpatient services with copays, and emergency services with a $120 copay. Primary care visits are covered with no copay, and preventive services, including an annual physical exam, also have no copay. Additional benefits include hearing and vision services, with hearing exams and eye exams having no copay. Dental services have copays depending on the specific service. The plan also covers services like home health with no copay, and offers an over-the-counter (OTC) allowance, and a meal benefit, both with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. For Inpatient Hospital-Acute, you'll pay no copay for days 1-5 and days 21-90, and a $40 copay for days 6-20, and for Inpatient Hospital Psychiatric, you'll pay a $150 copay for days 1-9 and no copay for days 10-90.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and ambulatory surgical center services, are covered. Outpatient hospital services have a $225 copay, observation services have a $175 copay, and ambulatory surgical center services have a $75 copay. Outpatient substance abuse services, including individual and group sessions, are covered with a copay of $15.00. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the AvMed Medicare Access (HMO-POS) plan, with a $15 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the AvMed Medicare Access (HMO-POS) plan, with a $165 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation Services to a plan-approved health-related location are covered with no copay, up to 12 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the AvMed Medicare Access (HMO-POS) plan. Emergency Services have a $120 copay, Urgently Needed Services have a copay between $20 and $50, and Worldwide Emergency Coverage has a $120 copay. Worldwide Urgent Coverage has a $50 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The AvMed Medicare Access (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $5 copay, occupational therapy services with a $15 copay, physician specialist services with a $15 copay, and physical therapy and speech-language pathology services with a $20 copay. Mental health and psychiatric services, other health care professional visits, and opioid treatment program services have a $15 copay for individual and group sessions. Podiatry services and additional telehealth benefits are also covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, an annual physical exam with no copay, and additional preventive services. Other services covered include Health Education, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, and Fitness Benefit, all with no copay. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $5 copay, fitting/evaluation for hearing aids, and prescription hearing aids, though routine hearing exams and prescription hearing aids for the inner, outer, and over the ear are not covered. Prescription hearing aids have a maximum benefit of $1,000 every two years and allow for 2 visits.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have no copay, and eyewear has no copay with a combined maximum benefit of $350 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a copay between $15 and $225, and other dental services such as oral exams with a copay between $0 and $40, dental x-rays with a copay between $0 and $35, other diagnostic dental services with a copay between $0 and $8, prophylaxis (cleaning) with a copay between $0 and $45, fluoride treatment with no copay, and other preventative dental services with no copay. Additionally, restorative services have a copay between $22 and $530, adjunctive general services have a copay between $0 and $165, endodontics have a copay between $22 and $535, periodontics have a copay between $0 and $435, prosthodontics (removable) have a copay between $0 and $700, prosthodontics (fixed) have a copay between $0 and $550, and oral and maxillofacial surgery has a copay between $0 and $175. Maxillofacial prosthetics, implant services, 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 coinsurance between 0% and 20%. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the AvMed Medicare Access (HMO-POS) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the AvMed Medicare Access (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have no copay, and Medical Supplies have a 20% coinsurance. Diabetic Supplies have no coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $5 and $25, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $100, while Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the AvMed Medicare Access (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the AvMed Medicare Access (HMO-POS) plan, but the specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the AvMed Medicare Access (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $135 copay for days 21-100, while additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The AvMed Medicare Access (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, a maximum benefit coverage amount of $50 every three months. The plan also covers a Meal Benefit with no copay and requires prior authorization. However, 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.
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