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 2026, 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 2026.
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. Additionally, this plan comes with a Part B Premium reduction of $10.00. You must continue to pay paying your reduced 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) Medicare plan offers prescription drug coverage with a $0 drug deductible, meaning your benefits begin immediately. Under this plan, you will pay no copay for Tier 1 preferred generics, Tier 2 generics, Tier 3 preferred brands, and Tier 6 supplemental drugs through standard pharmacies and mail-order services. This makes a wide variety of essential medications highly affordable with no out-of-pocket costs for up to a three-month supply. For Tier 4 non-preferred drugs, you will face a standard copay of $55 for a one-month supply, $110 for a two-month supply, and $165 for a three-month supply. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply through standard retail or mail-order pharmacies. These structured costs help you easily budget for your prescription medication needs throughout the year.
Additional Benefits
The DrMax (HMO) plan offers comprehensive coverage with no copays and no coinsurance for many essential services, including inpatient hospital stays, primary and specialist care, and preventive visits. Members also benefit from routine dental, vision, and hearing services with no copays, which includes allowances for eyewear and hearing aids. Additionally, home health care and unlimited round-trip transportation to plan-approved locations are covered at no cost to the member. For outpatient and emergency services, the plan requires manageable out-of-pocket costs, such as a $50 copay for outpatient hospital visits and a $100 copay for emergency room care. Certain specialized benefits like dialysis, durable medical equipment, and Part B drugs require a coinsurance of up to 20%. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a $75 daily copay for days 21 through 100.
Inpatient Hospital See details
DrMax (HMO) inpatient hospital benefits are partially covered with no copay and no coinsurance, though prior authorization is required. While unlimited additional days are covered for acute care, additional psychiatric days and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
DrMax (HMO) covers outpatient hospital and ambulatory surgical center services with a $50 copay and no coinsurance, and outpatient blood services are covered with no copay, no coinsurance, and no deductible. Some outpatient substance abuse services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
DrMax (HMO) covers partial hospitalization services with no copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DrMax (HMO), featuring ground ambulance services with a $125 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Unlimited round-trip transportation to plan-approved health-related locations is covered with no copay and no coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
DrMax (HMO) covers emergency services with a $100 copay and no coinsurance (waived if admitted to the hospital within 24 hours), and urgently needed services with no copay and no coinsurance. Worldwide emergency services are partially covered up to a $50,000 maximum with no coinsurance, requiring a $125 copay for emergency care and a $25 copay for urgent care, while worldwide emergency transportation is not covered.
Primary Care See details
DrMax (HMO) covers primary care, specialist, and therapy services with no copay and no coinsurance, though some benefits require prior authorization or referrals. Routine chiropractic and podiatry care are covered with annual visit limits, but other chiropractic services and individual or group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Preventive services are partially covered by DrMax (HMO) with no copay and no coinsurance for covered care, including Medicare-covered preventive services, health education, and fitness benefits. However, an annual physical exam and several supplemental services, such as in-home safety assessments, personal emergency response systems, and nutritional benefits, are not covered.
Hearing Services See details
DrMax (HMO) covers hearing services with no copay and no coinsurance for routine exams and prescription hearing aids, up to a maximum benefit of $1,350 every two years. While exams are covered, this benefit is only partially covered as OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
DrMax (HMO) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam per year and up to $400 annually for eyewear such as contacts, eyeglasses, and upgrades. Other eye exam services are not covered under this plan.
Dental Services See details
Dental Services are partially covered by DrMax (HMO) with no copay and no coinsurance for covered benefits, although prior authorization is required for some treatments. Services that are not covered under this plan include other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
DrMax (HMO) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by DrMax (HMO) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these benefits.
Medical Equipment See details
DrMax (HMO) covers durable medical equipment with no copay and 0% to 20% coinsurance, though prosthetic and diabetic equipment benefits are only partially covered. Under these benefits, prosthetic devices and diabetic supplies are covered with no copay and 0% to 20% coinsurance, but medical supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by DrMax (HMO), with covered diagnostic services requiring no copay and no coinsurance, while diagnostic procedures, tests, and lab services are not covered. Radiological services require prior authorization and referrals, offering diagnostic radiological services with no copay and therapeutic radiological services with a copay and 20% coinsurance, though outpatient X-ray services are not covered.
Home Health Services See details
DrMax (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by DrMax (HMO) with no copay and no coinsurance, subject to prior authorization. While some services are covered, specific sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
DrMax (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, allowing for admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $75 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services under DrMax (HMO) are partially covered with no copay and no coinsurance, including up to 20 acupuncture treatments per year, chronic illness meal benefits, and an $80 monthly over-the-counter allowance. However, naloxone, dual-eligible SNPs, and certain other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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