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DrTotalCare-CFL (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrTotalCare-CFL (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrTotalCare-CFL (HMO C-SNP) in 2026, please refer to our full plan details page.
DrTotalCare-CFL (HMO C-SNP) is a HMO C-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 DrTotalCare-CFL (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DrTotalCare-CFL (HMO C-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 DrTotalCare-CFL (HMO C-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 DrTotalCare-CFL (HMO C-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. Additionally, this plan comes with a Part B Premium reduction of $1.00. 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 $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 DrTotalCare-CFL (HMO C-SNP) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generics, Tier 2 generics, and Tier 6 supplemental drugs through standard pharmacies and standard mail order services. This makes everyday medications highly affordable whether you choose a one-month, two-month, or three-month supply. For brand-name and specialty medications, the plan uses predictable copays and coinsurance at standard pharmacies and standard mail order. Tier 3 preferred brands require a $20 copay for a one-month supply, while Tier 4 non-preferred drugs carry a $60 copay per month. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply, with no multi-month supply options available.
Additional Benefits
The DrTotalCare-CFL (HMO C-SNP) plan offers comprehensive coverage with many services featuring no copayments or coinsurance. Members enjoy no copay for primary care visits, telehealth, home health services, and preventive care, while specialist visits and routine therapies require a low $10 copay. For hospital stays, there is no coinsurance, and inpatient acute stays feature no copay for days 1 to 2 and days 11 and beyond, though days 3 to 10 require a $100 daily copay. Essential health benefits like routine dental, vision exams with a $350 eyewear allowance, and hearing services—including prescription hearing aids up to $1,500—are covered with no copay or coinsurance. Diagnostic laboratory tests, outpatient X-rays, and diagnostic radiology are also available with no copay or coinsurance. Other services, such as durable medical equipment and dialysis, require no copay but carry a coinsurance ranging up to 20 percent.
Inpatient Hospital See details
DrTotalCare-CFL (HMO C-SNP) covers inpatient hospital services with no coinsurance, although prior authorization is required. Acute hospitalizations feature no copay for days 1-2 and days 11 and beyond, with a $100 daily copay for days 3-10, while psychiatric stays require a $165 daily copay for days 1-4 and no copay for days 5-90. Non-Medicare-covered stays and additional psychiatric days are not covered.
Outpatient Services See details
DrTotalCare-CFL (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $150 copay for outpatient hospital services and a $25 copay for ambulatory surgical center services. Outpatient substance abuse services require a $25 copay for individual sessions and a $10 copay for group sessions, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
DrTotalCare-CFL (HMO C-SNP) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DrTotalCare-CFL (HMO C-SNP), featuring a $200 copay and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Transportation services are partially covered with no copay or coinsurance for up to 24 one-way trips per year to plan-approved health-related locations, while trips to any health-related location are not covered.
Emergency Services See details
DrTotalCare-CFL (HMO C-SNP) covers emergency services with a $120 copay and no coinsurance, and urgently needed services with a $10 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are partially covered up to a $10,000 maximum benefit with no coinsurance, requiring a $250 copay for emergency care and a $50 copay for urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
DrTotalCare-CFL (HMO C-SNP) provides primary care, telehealth, and opioid treatment services with no copay and no coinsurance, though other chiropractic services are not covered. Most specialist, therapy, routine chiropractic, and podiatry visits require a $10 copay and no coinsurance, while individual mental health and psychiatric sessions carry a $25 copay and no coinsurance.
Preventive Services See details
Preventive services are partially covered by DrTotalCare-CFL (HMO C-SNP) with no copay and no coinsurance for covered services such as health education, kidney disease education, and diabetes training. However, the plan does not cover annual physical exams, fitness benefits, counseling, telemonitoring, remote access, weight management, alternative therapies, therapeutic massage, wigs, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, medication reconciliation, re-admission prevention, PERS, or home safety assessments and modifications.
Hearing Services See details
DrTotalCare-CFL (HMO C-SNP) covers hearing exams and prescription hearing aids with no copay and no coinsurance, including unlimited routine exams and one fitting evaluation every two years. While prescription hearing aids are covered up to a $1,500 maximum every two years, OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DrTotalCare-CFL (HMO C-SNP) with no copay, no coinsurance, and no deductible, though other eye exam services are not covered. Covered benefits include one routine eye exam per year and a $350 annual limit for eyewear, including contact lenses and eyeglasses.
Dental Services See details
Dental Services are partially covered by DrTotalCare-CFL (HMO C-SNP) with no copay and no coinsurance for all covered services, although prior authorization is required for several comprehensive treatments. Services not covered under this plan include other diagnostic dental, other preventive dental, adjunctive general, maxillofacial prosthetics, fixed prosthodontics, and orthodontic services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DrTotalCare-CFL (HMO C-SNP) with no copay and no coinsurance, requiring prior authorization and step therapy. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin requires a $35 copay and up to 20% coinsurance.
Dialysis Services See details
DrTotalCare-CFL (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization and a referral are required to access these covered services.
Medical Equipment See details
Medical Equipment is partially covered under the DrTotalCare-CFL (HMO C-SNP) plan with no copay and coinsurance ranging from no coinsurance to 20%. While durable medical equipment, prosthetic devices, and diabetic supplies are covered with prior authorization, medical supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DrTotalCare-CFL (HMO C-SNP), offering diagnostic services with no coinsurance, no copay for lab services, and a copay of $0 to $75 for diagnostic procedures. Radiological services require referrals and prior authorization, featuring no copay for outpatient X-rays and diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by DrTotalCare-CFL (HMO C-SNP) with no copay and no coinsurance. To receive these covered services, both a referral and prior authorization are required.
Cardiac Rehabilitation Services See details
DrTotalCare-CFL (HMO C-SNP) covers some Cardiac Rehabilitation Services with no coinsurance, but specific services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered and require a $10 copay. Prior authorization and referrals are also required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DrTotalCare-CFL (HMO C-SNP) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $125 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DrTotalCare-CFL (HMO C-SNP) partially covers Other Services, providing a chronic illness meal benefit with no copay and no coinsurance, subject to prior authorization and referral requirements. Acupuncture and Over-the-Counter (OTC) items are not covered under this plan's benefit.
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