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DrPlatinum-CFL (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrPlatinum-CFL (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrPlatinum-CFL (HMO D-SNP) in 2026, please refer to our full plan details page.
DrPlatinum-CFL (HMO D-SNP) is a HMO D-SNP plan offered by DOCTORS HEALTHCARE PLANS, INC. available for enrollment in 2026 to people living in Counties: HSB, ORG, OSC, PSC, PLK, SEM. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DrPlatinum-CFL (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:
DrPlatinum-CFL (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 DrPlatinum-CFL (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 DrPlatinum-CFL (HMO D-SNP), 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 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 DrPlatinum-CFL (HMO D-SNP) Medicare plan has an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 supplemental drugs filled at standard pharmacies or through standard mail order. This makes essential generic medications highly affordable and accessible for plan members. For brand-name and specialty medications, members are responsible for a 25% coinsurance rather than a flat copay. This 25% coinsurance rate applies to Tier 3 preferred brand drugs, Tier 4 non-preferred drugs, and Tier 5 specialty drugs filled at standard pharmacies or through standard mail order.
Additional Benefits
The DrPlatinum-CFL (HMO D-SNP) plan offers comprehensive healthcare coverage with very low out-of-pocket costs, featuring no copay and no coinsurance for inpatient and outpatient hospital stays, primary and specialist care, and skilled nursing. Beneficiaries also enjoy extensive dental, vision, and hearing benefits with no copay, which includes an annual $400 eyewear allowance and up to $1,500 every two years for prescription hearing aids. Additionally, the plan covers up to 80 one-way trips per year to approved medical locations at no cost to the member. While many services have no cost-sharing, members are responsible for a $50 copay for emergency room visits and a $75 copay for ground ambulance services. There is also a 20% coinsurance for dialysis and air ambulance services, as well as up to 20% coinsurance for durable medical equipment and Medicare Part B drugs. Some services are excluded from this plan, including cardiac rehabilitation, acupuncture, and over-the-counter items.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DrPlatinum-CFL (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required. Under this coverage, non-Medicare-covered stays for acute and psychiatric care, along with additional days for psychiatric hospitalizations, are not covered.
Outpatient Services See details
DrPlatinum-CFL (HMO D-SNP) covers outpatient hospital, ambulatory surgical center, and blood services with no copay and no coinsurance. For outpatient substance abuse services, some services are covered but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered by DrPlatinum-CFL (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
DrPlatinum-CFL (HMO D-SNP) covers ground ambulance services with a $75 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation benefits are partially covered, offering up to 80 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
DrPlatinum-CFL (HMO D-SNP) covers emergency services with a $50 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services are covered with no copay or coinsurance, and worldwide emergency and urgent services are partially covered up to a $10,000 maximum with no copay or coinsurance, excluding worldwide emergency transportation.
Primary Care See details
DrPlatinum-CFL (HMO D-SNP) provides primary care, specialist, therapy, and telehealth services with no copay and no coinsurance. Chiropractic benefits are partially covered because other chiropractic services are excluded, and some mental health and psychiatric services are covered but individual and group sessions are not.
Preventive Services See details
Preventive services are partially covered under the DrPlatinum-CFL (HMO D-SNP) plan, offering covered benefits with no copay and no coinsurance. While services like kidney disease education, diabetes self-management, and health education are covered, several sub-services are not covered, including annual physical exams, fitness benefits, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
DrPlatinum-CFL (HMO D-SNP) partially covers hearing services with no copay and no coinsurance for covered exams and prescription hearing aids. This benefit includes unlimited routine hearing exams, one fitting evaluation every two years, and up to $1,500 every two years for prescription hearing aids, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
DrPlatinum-CFL (HMO D-SNP) offers partially covered vision services with no copay, no coinsurance, and no deductible, although other eye exam services are not covered. The plan includes one routine eye exam per year and up to $400 annually for eyewear, such as glasses, contacts, and upgrades.
Dental Services See details
DrPlatinum-CFL (HMO D-SNP) offers partially covered dental services with no copay and no coinsurance for covered preventive and comprehensive care. Covered benefits include exams, cleanings, x-rays, fluoride, restorative, endodontics, periodontics, prosthodontics, implants, and oral surgery, while other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
DrPlatinum-CFL (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the DrPlatinum-CFL (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization and a referral are required to access this benefit.
Medical Equipment See details
Medical equipment is partially covered by DrPlatinum-CFL (HMO D-SNP) with no copay and coinsurance ranging from no coinsurance to 20%, though prior authorization is required. Covered benefits include durable medical equipment, prosthetic devices, and diabetic supplies, while medical supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DrPlatinum-CFL (HMO D-SNP) with no copay and no coinsurance, but only some services are covered. Specifically, diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered by DrPlatinum-CFL (HMO D-SNP) with no copay and no coinsurance, although both a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DrPlatinum-CFL (HMO D-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
DrPlatinum-CFL (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no copay and no coinsurance, though prior authorization is required and additional days beyond Medicare-covered limits are not covered. This benefit allows for admission without a prior three-day hospital stay and features no cost-sharing on the day of discharge.
Other Services See details
Other Services under the DrPlatinum-CFL (HMO D-SNP) plan are partially covered, offering a meal benefit for chronic illness with no copay and no coinsurance, though prior authorization and a referral are required. Acupuncture and Over-the-Counter (OTC) items are not covered under this plan.
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