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AvMed Medicare One (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for AvMed Medicare One (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on AvMed Medicare One (HMO) in 2025, please refer to our full plan details page.
AvMed Medicare One (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 One (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 One (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 One (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 $1000.00 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 One (HMO)
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Drug Coverage
The AvMed Medicare One (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different copays depending on the drug tier and the pharmacy you use. 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 Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The AvMed Medicare One (HMO) plan offers comprehensive coverage, including no copay for inpatient hospital stays, observation services, and many primary care and preventive services. The plan also provides benefits for hearing and vision, with no copay for eye exams, and eyewear, and hearing exams, as well as prescription hearing aids with a maximum benefit. Dental services are covered, with varying copays. This plan covers a range of additional services, such as ambulance and emergency services, with copays ranging from $0 to $145. Other services, like outpatient services, partial hospitalization, and skilled nursing facility stays, have copays. Home health services, durable medical equipment, and medical supplies are covered, as well as home infusion bundled services, and diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital coverage under the AvMed Medicare One (HMO) plan includes inpatient hospital-acute and inpatient hospital psychiatric services, both with no copay. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $100 copay, Observation Services with no copay, Ambulatory Surgical Center (ASC) Services with a $25 copay, Outpatient Substance Abuse Services with a $15 copay for both individual and group sessions, and Outpatient Blood Services with no copay. All services require prior authorization.
Partial Hospitalization See details
Partial Hospitalization is covered by the AvMed Medicare One (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 includes coverage for ground ambulance services with a $145 copay, and 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, Urgently Needed Services, and Worldwide Emergency Coverage have a $100 copay, while Worldwide Urgent Coverage has no copay; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care services include coverage for Primary Care Physician services with no copay, Chiropractic Services with a $5 copay, Occupational Therapy Services with no copay, Physician Specialist Services with no copay, and Mental Health Specialty Services, with a $15 copay for individual and group sessions. The plan also covers Podiatry Services with a $5 copay for routine foot care, Other Health Care Professional services with no copay, Psychiatric Services with a $15 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with no copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $15 copay. However, Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive services include an annual physical exam with no copay, and other services like health education, in-home support services, remote access technologies, and fitness benefits with no copay. Other preventive services, such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and more, are not covered.
Hearing Services See details
Hearing Services with the AvMed Medicare One (HMO) plan includes hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with no copay, and a maximum plan benefit of $1500.00 per ear every two years; however, prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams and eyewear benefits. Eye exams have no copay, and routine eye exams are covered annually. Eyewear has no copay, and includes contact lenses and eyeglasses (lenses and frames) with a combined maximum plan benefit of $450 every year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The AvMed Medicare One (HMO) plan covers a variety 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 varying copays ranging from no copay to $922.00, and other services like maxillofacial prosthetics and orthodontics are not covered. Oral exams, dental x-rays, and other diagnostic dental services require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the AvMed Medicare One (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, and the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs can range from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the AvMed Medicare One (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
The AvMed Medicare One (HMO) plan covers Durable Medical Equipment (DME) with 10% coinsurance, and Prosthetic Devices and Medical Supplies with no copay. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, 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 copay up to $25, and outpatient X-ray services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by AvMed Medicare One (HMO) with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the AvMed Medicare One (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the AvMed Medicare One (HMO) plan, but prior authorization is required. There is no copay for days 1-20 and days 63-100, but there is a $160 copay for days 21-62. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
AvMed Medicare One (HMO) covers acupuncture with no copay, up to 25 treatments per year, and over-the-counter items with no copay, up to $50 per month. The plan also offers a meal benefit with no copay for a chronic illness, and does not cover 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, or Self-Directed Personal Assistance Services.
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