A non-government entity
DrMax (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrMax (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrMax (HMO) in 2025, please refer to our full plan details page.
DrMax (HMO) is a HMO plan offered by DOCTORS HEALTHCARE PLANS, INC. available for enrollment in 2025 to people living in Miami-Dade County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that DrMax (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 DrMax (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 DrMax (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:
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Drug Coverage
The DrMax (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay no copay for preferred generic and standard generic drugs at standard or mail order pharmacies. For preferred brand drugs, you will pay a $55 copay, and for non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The DrMax (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with copays varying by service. The plan covers emergency services, primary care, preventive services, hearing, vision, and dental services. Additionally, the plan covers ambulance and transportation services, home infusion, dialysis, medical equipment, home health, and skilled nursing facility (SNF) services. This plan also provides coverage for specific services like acupuncture, over-the-counter items, and meal benefits for chronic illnesses. Hearing aids are covered up to $1350 every two years. Certain services, such as outpatient substance abuse, require prior authorization or have limitations.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered and require prior authorization. Additional Days for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay 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, including Outpatient Hospital Services and Observation Services, have a $50 copay per visit, while Ambulatory Surgical Center (ASC) Services have a $25 copay. Outpatient Substance Abuse Services are partially covered, with individual and group sessions not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by DrMax (HMO), including ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground ambulance services have a $125 copay, and air ambulance services have 20% coinsurance. 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 by the DrMax (HMO) plan. Emergency Services has a $75 copay, Worldwide Emergency Coverage has a $125 copay, and Worldwide Urgent Coverage has a $25 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic care covers 12 visits per year, and podiatry services cover 6 visits per year. Occupational Therapy and Physical Therapy and Speech-Language Pathology Services require prior authorization and referral. Individual and group sessions for Mental Health and Psychiatric Services are not covered.
Preventive Services See details
Preventive Services are covered by the DrMax (HMO) plan, although annual physical exams, in-home safety assessments, personal emergency response systems, 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 benefits, 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, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers Health Education and Fitness Benefits, and other services including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services under the DrMax (HMO) plan include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids, all of which are covered. The plan also covers prescription hearing aids up to $1350 every two years, but does not cover prescription hearing aids for the inner ear, outer ear, or over the ear. OTC hearing aids are not covered.
Vision Services See details
The DrMax (HMO) plan covers vision services, including routine eye exams with one visit per year, and eyewear with a combined maximum benefit of $400 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The DrMax (HMO) plan covers a variety of dental services, including oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable), implant services, and oral and maxillofacial surgery. Adjunctive general services, maxillofacial prosthetics, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the DrMax (HMO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the DrMax (HMO) plan, but require prior authorization and a doctor referral. The coinsurance for this benefit is 20%.
Medical Equipment See details
Medical Equipment benefits under the DrMax (HMO) plan include Durable Medical Equipment (DME) with a 0-20% coinsurance and no copay, though Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit and Diabetic Supplies are covered with a 0-20% coinsurance and no copay, while Prosthetic Devices have a 0-20% coinsurance and no copay, and Medical Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the DrMax (HMO) plan. Diagnostic Radiological Services have a copay of up to $75.00, while Therapeutic Radiological Services have a copay of up to $75.00; however, Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by DrMax (HMO), with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the DrMax (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $60 copay for days 21-100.
Other Services See details
Under Other Services, DrMax (HMO) covers acupuncture with prior authorization, up to 20 treatments per year, and over-the-counter items with a $75 monthly benefit. The plan also covers meal benefits for chronic illness with prior authorization and a doctor referral. Other services such as Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and others are not covered.
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