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DrMax-B (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrMax-B (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrMax-B (HMO) in 2025, please refer to our full plan details page.
DrMax-B (HMO) is a HMO plan offered by DOCTORS HEALTHCARE PLANS, INC. available for enrollment in 2025 to people living in Broward County. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that DrMax-B (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-B (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-B (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.
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 DrMax-B (HMO)
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Drug Coverage
The DrMax-B (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, preferred generic drugs and specialty tier drugs have no copay at standard pharmacies, while standard generic drugs have a $15 copay and preferred brand drugs have a $75 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. However, if you qualify for the low-income subsidy (LIS), you may have reduced premium costs.
Additional Benefits
The DrMax-B (HMO) plan offers a range of benefits, including inpatient hospital, outpatient services, and primary care services, as well as coverage for hearing, vision, and dental services. The plan has a $90 copay for emergency services and a $200 copay for ground ambulance services. The plan also includes coverage for home infusion, medical equipment, and diagnostic services with varying cost-sharing, and offers no copay for home health services. There is a $60 per day copay for days 21-100 for skilled nursing facility services. Routine hearing exams and vision exams are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, but Non-Medicare-covered Stay for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered. Prior authorization is required.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services each have a $50 copay, while Outpatient Substance Abuse Services are not covered and Outpatient Blood Services have a three (3) pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the DrMax-B (HMO) plan, but requires prior authorization. The plan does not specify any cost-sharing details such as copay or coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by DrMax-B (HMO). Ground ambulance services have a $200 copay, and air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered, and transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services under the DrMax-B (HMO) plan include a $90 copay, and no coinsurance, as well as no copay for urgently needed services. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $25 copay, and Worldwide Emergency Transportation is not covered.
Primary Care See details
The DrMax-B (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Routine chiropractic care is limited to 12 visits per year, and individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
Preventive services are covered, including health education and fitness benefits. However, annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, 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, and counseling services are not covered.
Hearing Services See details
Hearing Services for the DrMax-B (HMO) plan include routine hearing exams and fitting/evaluation for hearing aids with no copay or coinsurance, and prescription hearing aids with a maximum benefit of $1000 every two years. Prescription hearing aids (inner ear, outer ear, and over the ear) and OTC hearing aids are not covered.
Vision Services See details
The DrMax-B (HMO) plan covers vision services, including routine eye exams once per year, and eyewear with a combined maximum benefit of $350 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are covered under the DrMax-B (HMO) plan. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, endodontics, implant services, and oral and maxillofacial surgery are covered, while adjunctive general services, maxillofacial prosthetics, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the DrMax-B (HMO) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance between 0% and 20%, while other Medicare Part B drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the DrMax-B (HMO) plan. Prior authorization and a doctor referral are required, and you will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with a coinsurance of 0-20% and no copay, Prosthetic Devices with a coinsurance of 0-20% and no copay, and Diabetic Supplies with a coinsurance of 0-20% and no copay. Durable Medical Equipment for use outside the home, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the DrMax-B (HMO) plan. Diagnostic Radiological Services have a copay of up to $50, while Therapeutic Radiological Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered under the DrMax-B (HMO) plan, with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered but not covered in practice because the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the DrMax-B (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $60 per day.
Other Services See details
The DrMax-B (HMO) plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. The plan does cover a meal benefit, but requires prior authorization and a doctor's referral.
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