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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 Orange, Osceola and Seminole Counties. 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 $3000.00 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 an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy. For example, preferred generic drugs have no copay at a preferred pharmacy and a $15 copay at a standard pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for 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 a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays for many services. The plan covers ambulance and transportation services, with copays for ground ambulance and no copay for transportation to health-related locations. Primary care, preventive services, and vision services like eye exams and eyewear have no copays, while dental services are covered with a maximum annual benefit and coinsurance for some services. Hearing exams, prescription hearing aids, and many diagnostic services also have no copays. The plan also includes benefits like home health services, and a monthly allowance for over-the-counter items.
Inpatient Hospital See details
The AvMed Medicare One (HMO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $49 copay for days 1-6, and no copay for days 7-90, with no coinsurance; Additional Days for Inpatient Hospital-Acute have no copay. For Inpatient Hospital Psychiatric, you'll pay a $50 copay for days 1-5, and no copay for days 6-90, with no coinsurance.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $50 copay, Observation Services with a $49 copay, Ambulatory Surgical Center (ASC) Services with a $25 copay, Individual and Group Sessions for Outpatient Substance Abuse with a $10 copay, and Outpatient Blood Services with no copay. Prior authorization is required for most services.
Partial Hospitalization See details
Partial Hospitalization is covered by the AvMed Medicare One (HMO) plan, but requires prior authorization. The plan has a $25 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 $250 copay, while air ambulance services have 20% coinsurance. Transportation services to a plan-approved health-related location have no copay.
Emergency Services See details
Emergency Services are covered by the AvMed Medicare One (HMO) plan, with a $90 copay for emergency services and a $5 copay for urgently needed services; there is no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $120 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $5 copay (routine care is not covered), Occupational Therapy Services with a $10 copay, Physician Specialist Services with a $5 copay, Mental Health Specialty Services with a $10 copay for individual and group sessions, Podiatry Services with a $5 copay, Other Health Care Professional with a copay between $0 and $10, Psychiatric Services with a $10 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $10 copay, Additional Telehealth Benefits with a copay between $0 and $5, and Opioid Treatment Program Services with a $10 copay.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, an annual physical exam with no copay, and additional services including health education, in-home support services, and fitness benefit, all with no copay. Other services such as 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, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered with no copay.
Hearing Services See details
Hearing Services include hearing exams with a $5 copay, and fitting/evaluation for hearing aids with no copay. Prescription Hearing Aids are covered, with a maximum plan benefit of $1,000 per ear every two years, and Prescription Hearing Aids (all types) are covered with no copay.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have no copay, while routine eye exams have a $5 copay. Eyewear, including contact lenses and eyeglasses (lenses and frames), have no copay, and a combined maximum benefit of $450 per year, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a maximum benefit of $2,500 per year. Oral exams have no copay, while dental x-rays have a 0-50% coinsurance. Other services like restorative services have a 20-50% coinsurance, and implant services have a 50% coinsurance. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. The plan covers Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the AvMed Medicare One (HMO) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
The AvMed Medicare One (HMO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance, and also covers Prosthetic Devices with a 20% coinsurance. Diabetic Supplies have no copay, and Diabetic Therapeutic Shoes/Inserts have no copay and a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services and Outpatient X-Ray Services have no copay. Diagnostic and Therapeutic Radiological Services have a copay up to $25, with a minimum copay of $5.
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. 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 with prior authorization required. There is no copay for days 1-20, and a $196 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 One (HMO) plan's Other Services benefit covers Over-the-Counter (OTC) items with no copay, and a monthly maximum benefit of $50. The plan does not cover 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. The plan also provides a meal benefit with no copay, but requires prior authorization.
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