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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 2026, 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 and Broward Counties. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $1.10. 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 $615.00 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) Medicare plan has an annual drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs. This no-copay benefit applies to one-month, two-month, and three-month supplies filled at standard pharmacies and through standard mail order. For other medication categories, members are responsible for a 25% coinsurance. This 25% coinsurance applies to Tier 3 preferred brand and Tier 4 non-preferred drugs for up to a three-month supply, as well as Tier 5 specialty drugs for a one-month supply.
Additional Benefits
The DrFlex (HMO D-SNP) plan offers comprehensive coverage with no copay and no coinsurance for most core medical services, including inpatient hospital stays, primary care, specialist visits, and home health care. While key preventive and routine services cost nothing, members should expect a $50 copay for emergency room visits, a $75 copay for ground ambulance services, and a 20% coinsurance for dialysis. Covered medical equipment and Part B drugs also carry a coinsurance ranging up to 20%, with insulin capped at a $35 copay. In addition to medical care, the plan features rich supplemental benefits with no copay, including routine dental, a $400 annual eyewear allowance, and up to $1,500 for hearing aids every two years. Members also benefit from unlimited transportation to plan-approved locations and up to 20 routine acupuncture visits per year at no cost. Please note that certain benefits, such as cardiac rehabilitation and over-the-counter items, are not covered by this plan.
Inpatient Hospital See details
DrFlex (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no copay and no coinsurance, subject to prior authorization. This benefit is partially covered because non-Medicare-covered stays for both acute and psychiatric care, along with additional days for psychiatric care, are not covered.
Outpatient Services See details
DrFlex (HMO D-SNP) covers outpatient services, including outpatient hospital, ambulatory surgical center, and blood services, with no copay and no coinsurance. Outpatient substance abuse services are also covered with no copay or coinsurance, though individual and group sessions are not covered.
Partial Hospitalization See details
DrFlex (HMO D-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
DrFlex (HMO D-SNP) covers ambulance and transportation services, requiring a $75 copay for ground ambulance and a 20% coinsurance for air ambulance services. Transportation services are partially covered with no copay and no coinsurance for unlimited round trips to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
DrFlex (HMO D-SNP) covers emergency services with a $50 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay or coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum benefit with no copay or coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
DrFlex (HMO D-SNP) covers primary care, specialist, and therapy services with no copay and no coinsurance. Routine chiropractic (up to 12 visits yearly) and routine podiatry (up to 6 visits yearly) are covered, though other chiropractic services are not. Some mental health and psychiatric services are covered under the plan, but individual and group sessions are not covered.
Preventive Services See details
DrFlex (HMO D-SNP) preventive services are partially covered with no copay and no coinsurance for covered benefits like Medicare-covered zero-dollar preventive services, kidney disease education, and glaucoma screenings. However, several services are not covered, including annual physical exams, fitness benefits, weight management programs, and in-home safety assessments.
Hearing Services See details
Hearing services under DrFlex (HMO D-SNP) are covered with no copay and no coinsurance for routine exams and prescription hearing aids, which feature a $1,500 maximum coverage limit every two years. This benefit is partially covered because over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DrFlex (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible for covered care. This benefit includes one routine eye exam per year and up to a $400 annual allowance for eyewear, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by DrFlex (HMO D-SNP) with no copay and no coinsurance for covered benefits, though prior authorization is required for several services. Sub-services that are not covered under this plan include other diagnostic services, other preventive services, adjunctive general services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DrFlex (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Covered Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with insulin requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by DrFlex (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization and a referral are required to receive these covered services.
Medical Equipment See details
Medical Equipment is partially covered by DrFlex (HMO D-SNP), offering covered durable medical equipment, prosthetic devices, and diabetic supplies with no copay and coinsurance ranging from no coinsurance to 20%. Medical supplies and diabetic therapeutic shoes or inserts are not covered under this plan, and prior authorization is required for covered items.
Diagnostic and Radiological Services See details
DrFlex (HMO D-SNP) covers some diagnostic and radiological services with no copay and no coinsurance, but diagnostic procedures, lab services, diagnostic and therapeutic radiological services, and outpatient x-rays are not covered.
Home Health Services See details
Home health services are covered by DrFlex (HMO D-SNP) with no copay and no coinsurance, though both prior authorization and a referral are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DrFlex (HMO D-SNP) plan. All associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation services, are excluded from coverage.
Skilled Nursing Facility (SNF) See details
DrFlex (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, and does not require a three-day prior hospital stay before admission. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DrFlex (HMO D-SNP) offers partial coverage for other services, featuring acupuncture and chronic illness meal benefits with no copay and no coinsurance. Acupuncture is limited to 20 treatments per year, while over-the-counter (OTC) items are not covered.
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