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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 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 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 $1500.00 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 varying copays depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at preferred and mail order pharmacies. The plan also offers a catastrophic coverage phase where you pay nothing for covered drugs once your yearly out-of-pocket drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The AvMed Medicare One (HMO) plan offers comprehensive coverage with varying costs. Many services have no copay, including inpatient hospital stays (for a certain number of days), observation services, outpatient blood services, primary care, preventive services, hearing exams, contact lenses, oral exams, and home health services. Other services, like outpatient hospital services, emergency services, and ambulance services, have copays ranging from $5 to $180. The plan includes coverage for vision and dental services, with no copay for routine eye exams and a combined maximum benefit for eyewear, as well as no copay for many dental services. Additional benefits include coverage for hearing aids, durable medical equipment, and home infusion services. The plan also covers acupuncture, over-the-counter items, and a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the AvMed Medicare One (HMO) plan. Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services have no copay for days 1-90, and no copay for days 1-60, respectively. Additional Days for Inpatient Hospital-Acute also have no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include 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. Prior authorization is required for all of these services.
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 are covered by AvMed Medicare One (HMO). 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. Transportation services to any other health-related location is 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. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Additional Telehealth Benefits are covered with no copay. Chiropractic Services have a $5 copay, while Individual and Group Sessions for Mental Health and Psychiatric Services, and Opioid Treatment Program Services have a $15 copay. Podiatry Services, including Routine Foot Care, have a $5 copay.
Preventive Services See details
Preventive services include annual physical exams with no copay, as well as additional preventive services, kidney disease education services, and other preventive services. Health education, In-Home Support Services, Fitness Benefit, and Remote Access Technologies have no copay. In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, 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, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, and Telemonitoring Services are not covered.
Hearing Services See details
Hearing Services with AvMed Medicare One (HMO) includes coverage for hearing exams and fitting/evaluation for hearing aids with no copay, as well as coverage for prescription hearing aids with a plan-specified amount of $1500 per ear every two years, though inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams and eyewear. Routine eye exams and contact lenses have no copay, and eyewear has a combined maximum plan benefit coverage of $450 per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The AvMed Medicare One (HMO) plan covers a range of dental services with varying copays, including oral exams with no copay, dental x-rays with a copay between $0 and $147, and oral and maxillofacial surgery with a copay between $0 and $922. Prophylaxis (cleaning), fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), and implant services are also covered with no copay, while maxillofacial prosthetics 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, while 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 One (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
The AvMed Medicare One (HMO) plan covers Durable Medical Equipment (DME) with a 10% coinsurance, and Prosthetic Devices and Medical Supplies with no copay. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the AvMed Medicare One (HMO) plan, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $25, Lab Services have no copay, Diagnostic Radiological Services have a copay between $25 and $50, Therapeutic Radiological Services have a copay between $0 and $25, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the AvMed Medicare One (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 the specific sub-services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required, and copay information is available in the plan details.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by AvMed Medicare One (HMO), but require prior authorization. There is no copay for days 1-20 and days 63-100, but there is a $135 copay for days 21-62.
Other Services See details
The AvMed Medicare One (HMO) plan covers acupuncture with no copay, up to 25 treatments per year. Over-the-counter items are covered with no copay, up to a maximum of $50 per month, and the plan offers Naloxone coverage. The plan also covers a meal benefit with no copay for chronic illness, but does not cover Dual Eligible SNPs with Highly Integrated Services. The plan does not cover 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.
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