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DrSelect (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrSelect (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrSelect (HMO) in 2025, please refer to our full plan details page.
DrSelect (HMO) is a HMO 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 DrSelect (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 DrSelect (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 DrSelect (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 $3000.00 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 DrSelect (HMO) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you will pay no copay for preferred and standard generic drugs. For preferred and standard brand drugs, you will pay a $55 copay. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The DrSelect (HMO) plan offers a variety of benefits, including coverage for inpatient and outpatient services, emergency care, and primary care. You can expect copays for services like outpatient hospital visits ($75), ground ambulance ($125), and emergency services ($75). The plan also covers hearing, vision, and dental services, with specific allowances for hearing aids, eyewear, and various dental procedures. Additional benefits of the DrSelect (HMO) plan include home health services with no copay, and skilled nursing facility care with a copay after 20 days. Coverage is also available for home infusion, dialysis, medical equipment, and diagnostic services. However, some services like annual physical exams, personal emergency response systems, and certain dental and vision upgrades are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered under the DrSelect (HMO) plan. Additional Days for Inpatient Hospital-Acute and Upgrades for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services through DrSelect (HMO) include coverage for outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient hospital services and observation services have a $75 copay, and ambulatory surgical center services have a $25 copay, while outpatient blood services have a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the DrSelect (HMO) plan, but requires prior authorization. The copay and coinsurance for this benefit are not mentioned in the provided information.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the DrSelect (HMO) plan. Ground ambulance services have a $125 copay, while air ambulance services have 20% coinsurance. Transportation Services to a plan-approved health-related location are covered. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by DrSelect (HMO). Emergency Services have a $75 copay, Worldwide Emergency Coverage has a $125 copay, and Worldwide Urgent Coverage has a $25 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The DrSelect (HMO) plan covers primary care physician services, chiropractic services (12 visits per year), occupational therapy services (prior authorization and referral required, no copay and no coinsurance), physician specialist services (prior authorization and referral required), podiatry services (6 visits per year for routine foot care), physical therapy and speech-language pathology services (prior authorization and referral required, no copay and no coinsurance), and additional telehealth benefits. Individual and group sessions for mental health and psychiatric services are not covered.
Preventive Services See details
The DrSelect (HMO) plan covers preventive services, including health education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, this plan does not cover annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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, or counseling services.
Hearing Services See details
Hearing services are covered by the DrSelect (HMO) plan, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to a plan-specified amount of $1,350 every two years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The DrSelect (HMO) plan covers vision services, including routine eye exams once per year, and eyewear with a combined maximum benefit of $400 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The DrSelect (HMO) plan covers oral exams (2 per year), dental x-rays (3 per year), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), restorative services (3 per year), endodontics (1 per year), periodontics (1 per 2 years), prosthodontics, removable (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 by DrSelect (HMO), including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with between 0% and 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the DrSelect (HMO) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the DrSelect (HMO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetic Devices with a coinsurance between 0% and 20%, but Durable Medical Equipment for use outside the home and Medical Supplies are not covered. Diabetic Supplies have a coinsurance between 0% and 20%, while Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The DrSelect (HMO) plan covers diagnostic and radiological services, though some services are not covered. Diagnostic procedures and tests, and lab services are not covered. Diagnostic Radiological Services have a copay of at most $75, and Therapeutic Radiological Services have a copay of at most $75, but Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the DrSelect (HMO) plan with no copay and no coinsurance, but prior authorization and a referral are required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover any of the sub-services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the DrSelect (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $60. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture and a meal benefit. Acupuncture is covered with a limit of 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.
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