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DrFlex (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrFlex (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrFlex (HMO D-SNP) in 2025, please refer to our full plan details page.
DrFlex (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 DrFlex (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:
DrFlex (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 DrFlex (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 DrFlex (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 DrFlex (HMO D-SNP) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after your deductible is met, you will pay 25% coinsurance for most drugs, except for those in the specialty tier, which have no copay. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The DrFlex (HMO D-SNP) plan offers a wide range of benefits with varying cost structures. Many services, such as primary care, preventive services, vision, and home health, have no copay. Other services, like ambulance, emergency services, and inpatient hospital, have copays or coinsurance. This plan covers dental services, hearing aids, and medical equipment with some cost-sharing. Diagnostic and radiological services have no copay, but several other services are not covered, including certain mental health services, alternative therapies, and cardiac rehabilitation.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric services, are covered, with prior authorization required. Additional days for Inpatient Hospital-Acute and upgrades for Inpatient Hospital-Acute are covered, but 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, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, are covered under the DrFlex (HMO D-SNP) plan; however, individual and group sessions for outpatient substance abuse are not covered. Outpatient blood services include a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered under the DrFlex (HMO D-SNP) plan. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the DrFlex (HMO D-SNP) plan. Ground ambulance services have a $50 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered, but transportation to any other health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the DrFlex (HMO D-SNP) plan, with a $75 copay and no coinsurance. Urgently Needed Services are covered with no copay and no coinsurance, while Worldwide Emergency Services are covered up to $50,000. Worldwide Emergency Transportation is not covered.
Primary Care See details
The DrFlex (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services include 12 visits per year, and Podiatry Services include 6 visits per year. Mental Health Specialty Services, specifically individual and group sessions, are not covered. Occupational Therapy and Physical Therapy have no copay or coinsurance, but do require authorization and a referral.
Preventive Services See details
The DrFlex (HMO D-SNP) plan covers Medicare-covered preventive services with no copay, and also covers additional preventive services including 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. 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, 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, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing Services include coverage for routine hearing exams and fitting/evaluation for hearing aids with no copay, and prescription hearing aids (all types) with a maximum plan benefit coverage of $1500 every two years. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
The DrFlex (HMO D-SNP) plan covers vision services, including routine eye exams once per year. Eyewear is covered with a combined maximum benefit of $400 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The DrFlex (HMO D-SNP) plan covers dental services, including oral exams (2 per year), dental x-rays (3 per year, including 2 bitewing x-rays per year and 1 panoramic x-ray every 3 years), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), restorative services (7 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the DrFlex (HMO D-SNP) plan, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the DrFlex (HMO D-SNP) plan, but require prior authorization and a doctor referral. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered by the DrFlex (HMO D-SNP) plan. Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, and Prosthetic Devices have a coinsurance between 0% and 20%, while Diabetic Supplies have a coinsurance between 0% and 20%; however, Durable Medical Equipment for use outside the home and Medical Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the DrFlex (HMO D-SNP) plan, though Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for this benefit.
Home Health Services See details
Home Health Services are covered by the DrFlex (HMO D-SNP) plan with no copay and no coinsurance, but require 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 not in practice. This plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the DrFlex (HMO D-SNP) plan, but additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered. Prior authorization is required.
Other Services See details
Other Services includes acupuncture and meal benefits, with prior authorization and a doctor referral required for both. Acupuncture is limited to 20 treatments per year, while 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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