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DrPlus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrPlus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrPlus (HMO D-SNP) in 2026, please refer to our full plan details page.
DrPlus (HMO D-SNP) is a HMO D-SNP 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 DrPlus (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DrPlus (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DrPlus (HMO D-SNP).
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 DrPlus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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:
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Drug Coverage
The DrPlus (HMO D-SNP) prescription drug plan has an annual drug deductible of $615. You will benefit from no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 supplemental drugs when using standard pharmacies or standard mail order services. For brand-name and higher-tier medications, you will pay a 25% coinsurance. This 25% coinsurance rate applies to Tier 3 preferred brands, Tier 4 non-preferred drugs, and Tier 5 specialty drugs through standard pharmacies and standard mail order.
Additional Benefits
The DrPlus (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays and no coinsurance for most primary care, specialist visits, inpatient hospital stays, and outpatient services. Members also benefit from no copays and no coinsurance for emergency care, home health, and skilled nursing facility services, though some benefits require prior authorization. While many services are fully covered, certain treatments like dialysis and air ambulance services require a 20% coinsurance, and Part B insulin drugs have a $35 copay. Ancillary benefits under this plan include routine dental, vision, and hearing services with no copay and no coinsurance, subject to specific annual or biennial coverage limits. Additionally, members can access unlimited round-trip transportation to plan-approved locations and an over-the-counter allowance of up to $102 per month at no cost. However, certain services like ground ambulance transport and cardiac rehabilitation are not covered under this plan.
Inpatient Hospital See details
DrPlus (HMO D-SNP) covers inpatient hospital services, including acute and psychiatric stays, with no copay and no coinsurance, although prior authorization is required. While unlimited additional days for acute stays are covered, additional days for psychiatric care and non-Medicare-covered stays for both acute and psychiatric services are not covered.
Outpatient Services See details
DrPlus (HMO D-SNP) covers outpatient services with no copay and no coinsurance, including outpatient hospital, ambulatory surgical center, and outpatient blood services with no deductible. For outpatient substance abuse, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization benefits are covered by DrPlus (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by DrPlus (HMO D-SNP), offering air ambulance services with no copay and 20% coinsurance, while ground ambulance services are not covered. Unlimited round-trip transportation to plan-approved health-related locations is covered with no copay and no coinsurance, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency and urgently needed services are covered by DrPlus (HMO D-SNP) with no copay and no coinsurance. Worldwide emergency and urgent services are partially covered with no copay or coinsurance up to a $50,000 maximum benefit, though worldwide emergency transportation is not covered.
Primary Care See details
DrPlus (HMO D-SNP) covers primary care, specialist, therapy, and telehealth services with no copay and no coinsurance. Chiropractic care is partially covered, excluding other chiropractic services, while mental health specialty and psychiatric services cover some services but exclude individual and group sessions.
Preventive Services See details
Preventive Services are partially covered by DrPlus (HMO D-SNP) with no copay and no coinsurance for covered benefits, including Medicare-covered preventive services, kidney disease education, and diabetes self-management training. Some services are not covered under this plan, such as annual physical exams, fitness benefits, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services are covered by DrPlus (HMO D-SNP) with no copay and no coinsurance, including unlimited routine exams and one fitting evaluation every two years. Prescription hearing aids are covered up to $1,300 every two years with no copay or coinsurance, but OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by DrPlus (HMO D-SNP) with no copay and no coinsurance, which includes one routine eye exam per year, though other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance up to a $400 combined maximum benefit per year for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by DrPlus (HMO D-SNP) with no copay and no coinsurance for all covered dental care, though prior authorization is required for some treatments. Non-covered sub-services include other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DrPlus (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DrPlus (HMO D-SNP) plan with no copay and a 20% coinsurance. Both prior authorization and a referral are required for this benefit.
Medical Equipment See details
DrPlus (HMO D-SNP) partially covers medical equipment with no copay and coinsurance ranging from no coinsurance to 20% coinsurance for durable medical equipment, prosthetic devices, and diabetic supplies. Prior authorization is required for these covered items, while medical supplies and diabetic therapeutic shoes or inserts are not covered under this plan.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by DrPlus (HMO D-SNP) with no copay and no coinsurance, though prior authorization and referrals are required for radiological services. In practice, some services are covered as diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by DrPlus (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DrPlus (HMO D-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
DrPlus (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, although prior authorization is required and additional days beyond the Medicare-covered limit are not covered. The plan allows for SNF admission without requiring a prior three-day inpatient hospital stay and charges no cost sharing on the day of discharge.
Other Services See details
Other Services are partially covered by DrPlus (HMO D-SNP) with no copay and no coinsurance for acupuncture, over-the-counter (OTC) items, and meal benefits. Under this plan, acupuncture is limited to 20 treatments annually and OTC items are capped at $102 per month, while naloxone and highly integrated dual-eligible SNP services are not covered.
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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