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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 2025, 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 2025.
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 $20.30. 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 $590.00 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) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after the deductible, you pay 25% coinsurance for most drugs, and no copay for specialty tier drugs. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The DrPlus (HMO D-SNP) plan offers a wide range of benefits with varying cost structures. Emergency services, hearing exams, and vision exams have no copay, and hearing aids are covered up to $1300 every two years. Many other services, such as outpatient services, skilled nursing facilities, and home infusion services, are covered, but may require prior authorization. The plan covers a variety of medical services including inpatient and outpatient care, primary care, and dental services. Costs vary, with some services having no copay or coinsurance, while others have coinsurance ranging from 0% to 20%. Additionally, the plan provides coverage for over-the-counter items up to $105 per month.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric care, are covered by the DrPlus (HMO D-SNP) plan. Additional days for Acute care are covered, while Non-Medicare-covered stays for both Acute and Psychiatric care, and additional days for Psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services, are covered by DrPlus (HMO D-SNP), though prior authorization is required for some services. Outpatient Substance Abuse Services are covered, but individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the DrPlus (HMO D-SNP) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by DrPlus (HMO D-SNP), including air ambulance services with a 20% coinsurance, but ground ambulance services and transportation services to any health-related location are not covered. Transportation services to plan-approved health-related locations are covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered by the DrPlus (HMO D-SNP) plan with no copay and no coinsurance. However, Worldwide Emergency Transportation is not covered.
Primary Care See details
The DrPlus (HMO D-SNP) plan covers primary care physician services, chiropractic services (including routine care with 12 visits per year), occupational therapy, physician specialist services, podiatry services (including routine foot care with 6 visits per year), other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Mental Health Specialty Services and Psychiatric Services do not cover individual or group sessions.
Preventive Services See details
Preventive Services are covered by the DrPlus (HMO D-SNP) plan, but annual physical exams are not covered. Additional services like Health Education, Support for Caregivers of Enrollees, Fitness Benefit, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered. Other services like In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are not covered.
Hearing Services See details
Hearing services include routine hearing exams and fitting/evaluation for hearing aids, with no copay or coinsurance. Prescription hearing aids (all types) are covered, with a plan maximum of $1300 every two years, and no copay or coinsurance. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services for the DrPlus (HMO D-SNP) plan include routine eye exams once per year, and eyewear benefits with a combined maximum of $400 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are covered by the DrPlus (HMO D-SNP) plan, including oral exams (2 per year), dental x-rays (2 bitewing X-rays per year and 1 panoramic X-ray every 3 years), cleaning (2 per year), fluoride treatments (2 per year), restorative services (7 per year), endodontics (1 per year), periodontics (scaling & root planing, one per quadrant per 2 years), removable prosthodontics (1 full upper and 1 full lower denture per 5 years or 1 upper partial and 1 lower partial denture per 5 years), implant services (1 per year), and oral and maxillofacial surgery (4 per year). Adjunctive general services, maxillofacial prosthetics, prosthodontics fixed, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the DrPlus (HMO D-SNP) plan and require prior authorization and a doctor referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered by DrPlus (HMO D-SNP), with Durable Medical Equipment (DME) coverage subject to a coinsurance between 0% and 20% and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay, with coinsurance for Medicare-covered Medical Supplies, and Prosthetic Devices are covered with a coinsurance between 0% and 20%. Diabetic Equipment is covered, with Diabetic Supplies coverage subject to a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the DrPlus (HMO D-SNP) plan, but diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by DrPlus (HMO D-SNP) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered, but prior authorization is required. Additional days beyond Medicare-covered stays, as well as non-Medicare-covered stays, are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a limit of 20 treatments per year and requires prior authorization. Over-the-counter items have a maximum benefit of $105.00 per month and the plan offers nicotine replacement therapy as a Part C OTC benefit. The meal benefit requires prior authorization and a doctor referral. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and more are not covered.
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