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DrElite-B (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrElite-B (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrElite-B (HMO) in 2025, please refer to our full plan details page.
DrElite-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 DrElite-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 DrElite-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 DrElite-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. Additionally, this plan comes with a Part B Premium reduction of $120.00. You must continue to pay paying your reduced 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 $4000.00 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 DrElite-B (HMO) plan has an "Enhanced Alternative" drug benefit. The plan has no deductible. During the initial coverage phase, you will pay varying copays or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs and specialty tier drugs, there is no copay. For standard generic drugs, the copay is $45.00. For preferred brand drugs, the copay is $90.00. For non-preferred drugs, you pay 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The DrElite-B (HMO) plan offers a wide array of benefits. This plan includes coverage for inpatient and outpatient hospital services, along with primary care, preventive, hearing, vision, and dental services. The plan has varying cost-sharing depending on the service. Some services, like preventive services and home health, have no copay, while others have copays ranging from $20 to $250 or coinsurance up to 20%. Additionally, there are limits on some services, such as hearing aids and eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For days 1-7 of an inpatient hospital stay, there is a $200 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a $200 copay, Observation Services with a $200 copay, Ambulatory Surgical Center (ASC) Services with a $100 copay, and Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions. Outpatient Blood Services are also covered, including a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization benefits are covered, but require prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by DrElite-B (HMO), with prior authorization required for all ambulance services. Ground ambulance services have a $250 copay, and air ambulance services have 20% coinsurance; transportation services to a plan-approved health-related location are covered, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services under the DrElite-B (HMO) plan includes a $120 copay, while Urgently Needed Services has a $25 copay; both have no coinsurance. Worldwide Emergency Coverage has a $150 copay and 20% coinsurance, and Worldwide Urgent Coverage has a $150 copay; however, Worldwide Emergency Transportation is not covered.
Primary Care See details
The DrElite-B (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy with a $20 copay, and specialist, mental health, podiatry, and psychiatric services with a $20 copay. The plan also covers physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a $0-$20 copay, and opioid treatment program services.
Preventive Services See details
The DrElite-B (HMO) plan covers preventive services, including Medicare-covered services with no copay, and additional preventive services such as health education and fitness benefits. Annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services include Routine Hearing Exams and Fitting/Evaluation for Hearing Aids with no copay or coinsurance. Prescription Hearing Aids (all types) are covered with a maximum plan benefit of $1000 every two years, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year, and eyewear including contact lenses, eyeglasses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
The DrElite-B (HMO) plan covers a range of dental services, including oral exams (2 per year), dental x-rays (2 bitewing per year, 1 panoramic every 3 years), prophylaxis (cleaning) (2 per year), fluoride treatment (2 per year), restorative services (3 per year), endodontics (1 per year), periodontics, and oral and maxillofacial surgery (2 per year). However, adjunctive general services, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the DrElite-B (HMO) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the DrElite-B (HMO) plan, with Durable Medical Equipment (DME) subject to 0%-20% coinsurance and no copay, and Prosthetic Devices subject to 0%-20% coinsurance. Diabetic Supplies are covered with 0%-20% coinsurance, while Diabetic Therapeutic Shoes/Inserts are subject to 20% coinsurance; however, Durable Medical Equipment for use outside the home and Medical Supplies are not covered.
Diagnostic and Radiological Services See details
The DrElite-B (HMO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $200, and outpatient X-ray services with no copay. Diagnostic radiological services have a copay between $25 and $200, while therapeutic radiological services have a copay up to $60 and a coinsurance of 20%. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the DrElite-B (HMO) 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 covered, but none of the sub-services are covered. A doctor referral and prior authorization are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the DrElite-B (HMO) plan, with prior authorization required. There is no copay for days 1-20, and a $175 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
Other Services include coverage for over-the-counter (OTC) items, up to $50 per month, including nicotine replacement therapy (NRT) but not acupuncture, meal benefits, or various other services. This plan does not require authorization or referrals for additional services.
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