A non-government entity
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 2025, 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 2025.
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:
Sign up for DrExtraCare (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The DrExtraCare (HMO C-SNP) plan has an enhanced alternative drug benefit with a $0 deductible. In the initial coverage phase, you will pay a copay for your prescriptions. For standard generic drugs, the copay is $20, and for preferred brand drugs, the copay is $55. For non-preferred drugs, you will pay 33% coinsurance. For specialty tier drugs, there is no copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase, and you will pay nothing for covered drugs.
Additional Benefits
The DrExtraCare (HMO C-SNP) plan offers a range of benefits, including coverage for inpatient and outpatient services, with copays ranging from $25 to $100 for specific services. You'll have access to primary care, preventive services with no copay, and coverage for hearing and vision services, with a yearly allowance for eyewear. The plan also covers dental services, home health services with no copay, and skilled nursing facility services with a $0 copay for the first 20 days. Additional benefits include ambulance and transportation services, emergency services with varying copays, and coverage for medical equipment and dialysis services, but some services like outpatient substance abuse, additional home health care, and certain dental and vision services are not covered. Prior authorization is required for some services, such as partial hospitalization, home infusion bundled services, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, though Non-Medicare-covered Stay for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute are covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered with a $50 copay, while ambulatory surgical center services have a $25 copay. Outpatient substance abuse services are not covered, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the DrExtraCare (HMO C-SNP) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the DrExtraCare (HMO C-SNP) plan. Ground ambulance services have a $100 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered, while transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the DrExtraCare (HMO C-SNP) plan. Emergency Services have a $75 copay, Worldwide Emergency Coverage has a $125 copay, and Worldwide Urgent Coverage has a $25 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation is not covered.
Primary Care See details
The DrExtraCare (HMO C-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. The plan also covers routine chiropractic care with a limit of 12 visits per year. Individual and group sessions for mental health specialty services and individual and group sessions for psychiatric services are not covered.
Preventive Services See details
The DrExtraCare (HMO C-SNP) plan covers preventive services, including Medicare-covered services with no copay, Health Education with no copay, and Fitness Benefit with no copay. However, it does not cover Annual Physical Exams, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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, or Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams and fitting/evaluation for hearing aids, with no copay and no coinsurance. Prescription hearing aids are covered up to $1,350 every two years, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The DrExtraCare (HMO C-SNP) plan covers vision services, including routine eye exams once per year. This plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $350 per year for eyewear.
Dental Services See details
The DrExtraCare (HMO C-SNP) plan covers a variety of dental services, including oral exams (2 per year), dental x-rays (3 per year), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), restorative services (5 per year), endodontics (1 per year), 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, and periodontics is covered with a limit of one periodontal scaling & root planing per quadrant every 2 years, and prosthodontics, removable covers 1 full upper and 1 full lower denture per 5 years or 1 upper partial and 1 lower partial denture per 5 years.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the DrExtraCare (HMO C-SNP) plan, with a $35 copay for Medicare Part B Insulin Drugs, and a coinsurance that ranges from 0% to 20% for all services. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the DrExtraCare (HMO C-SNP) plan and require prior authorization and a doctor referral. The coinsurance is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance on Medicare-covered medical supplies. Some services are covered, but Durable Medical Equipment for use outside the home and Medical Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the DrExtraCare (HMO C-SNP) plan. Diagnostic Radiological Services and Therapeutic Radiological Services are covered with a copay of up to $75, while Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the DrExtraCare (HMO C-SNP) plan with no copay and no coinsurance, but require both authorization and a referral. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but no specific services are covered under this plan. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the DrExtraCare (HMO C-SNP) plan, with a $0 copay for days 1-20 and a $60 copay for days 21-100. Additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The DrExtraCare (HMO C-SNP) plan covers acupuncture, but it is limited to 20 treatments per year and requires prior authorization and a doctor referral. Over-the-counter items, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved