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DrExtraCare (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrExtraCare (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrExtraCare (HMO C-SNP) in 2026, please refer to our full plan details page.
DrExtraCare (HMO C-SNP) is a HMO C-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 DrExtraCare (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DrExtraCare (HMO C-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 DrExtraCare (HMO C-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 DrExtraCare (HMO C-SNP), 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 $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 DrExtraCare (HMO C-SNP) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront costs. You will pay no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), Tier 3 (Preferred Brand), and Tier 6 (Supplemental Drugs) prescriptions filled for 1-month, 2-month, or 3-month supplies at standard pharmacies and standard mail order. This comprehensive coverage ensures that most common and supplemental medications are highly affordable. For Tier 4 (Non-Preferred Drugs), standard pharmacy and standard mail order copays are $55 for a 1-month supply, $110 for a 2-month supply, and $165 for a 3-month supply. Tier 5 (Specialty Tier) medications require a 33% coinsurance for a 1-month supply at standard pharmacies and standard mail order. These clear pricing tiers allow you to easily estimate your out-of-pocket prescription costs.
Additional Benefits
The DrExtraCare (HMO C-SNP) plan provides robust coverage for core medical needs, featuring no copays or coinsurance for inpatient hospital stays, primary care, specialist visits, and therapy services. Outpatient hospital services require a $50 copay, while emergency room visits carry a $100 copay which is waived if you are admitted. Additionally, ground ambulance services have a $100 copay, and the plan offers unlimited round-trip transportation to plan-approved locations with no copay. Routine dental, vision, and hearing care are highly accessible, with no copays or coinsurance for annual routine eye exams, dental care, and hearing exams, plus generous allowances for eyewear and hearing aids. For specialized needs, home health services and home infusions are available with no copay, while dialysis and medical equipment require up to a 20% coinsurance. Skilled nursing facility care is also covered with no copay for the first 20 days, followed by a $60 daily copay up to day 100.
Inpatient Hospital See details
DrExtraCare (HMO C-SNP) offers partially covered inpatient hospital benefits with no copay and no coinsurance for both acute and psychiatric stays, though prior authorization is required. While unlimited additional days are covered for acute stays, non-Medicare-covered stays for both acute and psychiatric care, as well as additional psychiatric days, are not covered.
Outpatient Services See details
DrExtraCare (HMO C-SNP) covers outpatient hospital services with a $50 copay and no coinsurance, and ambulatory surgical center services with a $25 copay and no coinsurance. Outpatient blood services are covered with no copay, no coinsurance, and no deductible, and while some outpatient substance abuse services are covered with no copay or coinsurance, individual and group sessions are not covered.
Partial Hospitalization See details
DrExtraCare (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DrExtraCare (HMO C-SNP), featuring a $100 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport, with prior authorization required. Transportation benefits are partially covered, offering unlimited round trips with no copay or coinsurance to plan-approved locations, while transport to any other health-related location is not covered.
Emergency Services See details
DrExtraCare (HMO C-SNP) covers emergency services with a $100 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with no copay or coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum limit with no coinsurance, featuring a $125 copay for emergency care and a $25 copay for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
DrExtraCare (HMO C-SNP) covers primary care, specialist, and therapy services with no copay and no coinsurance. Chiropractic care is partially covered, excluding other chiropractic services, and while some mental health and psychiatric services are covered, individual and group sessions are not.
Preventive Services See details
Preventive services are partially covered under DrExtraCare (HMO C-SNP) with no copay and no coinsurance for covered services like fitness benefits, kidney disease education, and diabetes self-management training. Several sub-services are not covered, including annual physical exams, in-home safety assessments, personal emergency response systems, and nutritional therapy.
Hearing Services See details
Hearing services are partially covered by DrExtraCare (HMO C-SNP) with no copay or coinsurance for routine hearing exams and one fitting evaluation every two years. Prescription hearing aids are covered with no copay or coinsurance up to a $1,350 maximum every two years, but OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DrExtraCare (HMO C-SNP), featuring no copay, no coinsurance, and no deductible for one routine eye exam per year, though other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is also covered with no copay or coinsurance up to a combined maximum benefit of $350 per year.
Dental Services See details
Dental Services are partially covered by DrExtraCare (HMO C-SNP) with no copay and no coinsurance for covered preventive and comprehensive care. Sub-services that are not covered include other diagnostic dental services, other preventive dental services, adjunctive general services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
DrExtraCare (HMO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under DrExtraCare (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Medical equipment is partially covered by DrExtraCare (HMO C-SNP) with no copay and coinsurance ranging from no coinsurance to 20%, subject to prior authorization. While durable medical equipment, prosthetic devices, and diabetic supplies are covered, 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 DrExtraCare (HMO C-SNP), offering no copay and no coinsurance for diagnostic services and diagnostic radiological services, while therapeutic radiological services require a copay and 20% coinsurance. Referrals and prior authorizations are required depending on the service, and diagnostic procedures, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by DrExtraCare (HMO C-SNP) with no copay and no coinsurance, though prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under DrExtraCare (HMO C-SNP) are structured so that some services are covered with no copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
DrExtraCare (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20 and a $60 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DrExtraCare (HMO C-SNP), featuring acupuncture up to 20 treatments per year and limited-duration meal benefits with no copay and no coinsurance, subject to prior authorization and referral requirements. Over-the-counter (OTC) items are not covered under this plan.
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