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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 Palm Beach 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 $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 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 pharmacies and mail order, while standard generic drugs have a $30 copay at preferred pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The AvMed Medicare One (HMO) plan offers a variety of benefits, including inpatient hospital stays with a copay, outpatient services, and emergency services. The plan also covers primary care, preventive, hearing, vision, and dental services with varying copays or no copays for some services. You'll also have coverage for medical equipment, diagnostic services, home health, and skilled nursing facility stays.
Inpatient Hospital See details
The AvMed Medicare One (HMO) plan covers inpatient hospital stays with a $49 copay for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a $150 copay for days 1-9, and no copay for days 10-90 for Inpatient Hospital Psychiatric. 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, are covered with a copay of $175 and $49, respectively. Ambulatory Surgical Center (ASC) services are covered with a $75 copay, and outpatient substance abuse services have a $15 copay for individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the AvMed Medicare One (HMO) plan, but requires prior authorization. The plan has a $15 copay for this benefit.
Ambulance and Transportation Services See details
The AvMed Medicare One (HMO) plan covers ambulance and transportation services. Ground ambulance services have a $240 copay, while air ambulance services have a 20% coinsurance, and transportation services have no copay.
Emergency Services See details
Emergency Services, including Urgent and Worldwide Emergency Coverage, are covered by the AvMed Medicare One (HMO) plan. Emergency Services have a $120 copay, Urgent Services have a $10 copay, and Worldwide Emergency Coverage has a $120 copay; Worldwide Emergency Transportation is not covered.
Primary Care See details
AvMed Medicare One (HMO) covers Primary Care Physician Services with no copay, Chiropractic Services with a $5 copay, Occupational Therapy Services with a $10 copay, Physician Specialist Services with a $20 copay, Mental Health Specialty Services with a $15 copay for individual and group sessions, Podiatry Services and Other Health Care Professional with a $5 copay, Psychiatric Services with a $15 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $10 copay, Additional Telehealth Benefits with no copay, and Opioid Treatment Program Services with a $15 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams with no copay, and additional preventive services with no copay for Health Education, In-Home Support Services, Fitness Benefits, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. 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, 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 include coverage for hearing exams with a $5 copay, and for fitting/evaluation for hearing aids, with no copay. Prescription Hearing Aids are covered, with a maximum benefit of $1200 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
The AvMed Medicare One (HMO) plan covers vision services, including eye exams with no copay, and routine eye exams with a $5 copay. Eyewear is covered with no copay, and there is a combined maximum benefit of $450 per year for contact lenses and eyeglasses. 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 $20 and $175, and Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, and Other Preventive Dental Services with no copay. Other Diagnostic Dental Services have a copay between $0 and $8, Restorative Services have a copay between $0 and $140, 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 have 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 by the AvMed Medicare One (HMO) plan and require prior authorization. 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 under the AvMed Medicare One (HMO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies with no copay. Diabetic Supplies have no coinsurance and Diabetic Therapeutic Shoes/Inserts have 20% coinsurance, while some services like Durable Medical Equipment for use outside the home are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $5 and $25, Lab Services with no copay, Diagnostic Radiological Services with a copay between $75 and $100, Therapeutic Radiological Services with a copay between $35 and $60, and Outpatient X-Ray Services with a $5 copay. Prior authorization is required for all diagnostic and radiological services.
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 not covered by the AvMed Medicare One (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the AvMed Medicare One (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $135 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The AvMed Medicare One (HMO) plan's "Other Services" benefit includes coverage for Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $150 every three months, and Meal Benefits with no copay and prior authorization required. 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.
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