A non-government entity
DrElite-SFL (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DrElite-SFL (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DrElite-SFL (HMO) in 2026, please refer to our full plan details page.
DrElite-SFL (HMO) is a HMO plan offered by DOCTORS HEALTHCARE PLANS, INC. available for enrollment in 2026 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 DrElite-SFL (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-SFL (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-SFL (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 $50.00. 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 DrElite-SFL (HMO) medicare plan features a $0 drug deductible, meaning you do not have to pay out-of-pocket before your prescription coverage begins. There is no copay for Tier 1 preferred generics, Tier 2 generics, or Tier 6 supplemental drugs filled at standard pharmacies or through standard mail order. This ensures that many common and essential medications are available to plan members at no cost. For higher-tier medications, Tier 3 preferred brand drugs carry a $47 copay for a one-month supply, while Tier 4 non-preferred drugs require a $100 copay. Tier 5 specialty drugs require a 33% coinsurance for a one-month supply at both standard pharmacies and mail order. Multi-month supplies for Tier 3 and Tier 4 medications are also available at proportional copay rates to help you manage your long-term prescription costs.
Additional Benefits
The DrElite-SFL (HMO) plan offers robust coverage with no copays or coinsurance for primary care, specialist visits, home health, and preventive services. For hospital stays, members pay a $100 daily copay for the first few days of inpatient care, followed by no copay for the remainder of their Medicare-covered stay. Emergency room visits require a $120 copay, while urgent care is available with a low $25 copay. This plan also features valuable supplemental benefits, including no-copay dental cleanings, routine vision exams with a $200 annual eyewear allowance, and routine hearing exams with up to $1,000 for hearing aids every two years. Additionally, members benefit from unlimited round-trip transportation to approved health locations and a $30 monthly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
DrElite-SFL (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $100 daily copay for days 1 through 6 of acute stays and days 1 through 5 of psychiatric stays, followed by no copay for remaining Medicare-covered days. Prior authorization is required, and non-Medicare-covered stays for both acute and psychiatric care, along with additional days for psychiatric stays, are not covered.
Outpatient Services See details
DrElite-SFL (HMO) covers outpatient services with no coinsurance, featuring a $50 copay for outpatient hospital services, a $25 copay for ambulatory surgical center services, and no copay for outpatient blood services. Some outpatient substance abuse services are covered with no copay or coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial hospitalization is covered under DrElite-SFL (HMO) with no copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
DrElite-SFL (HMO) covers ambulance services with a $150 copay for ground transport and a 20% coinsurance with no copay for air transport, both requiring prior authorization. Transportation services are partially covered, offering unlimited round trips 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
DrElite-SFL (HMO) covers emergency services with a $120 copay and urgent care with a $25 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with no coinsurance and copays of $200 and $100 respectively, though worldwide emergency transportation is not covered.
Primary Care See details
DrElite-SFL (HMO) provides primary care, specialist, therapy, telehealth, and podiatry services with no copay and no coinsurance. Chiropractic services are partially covered with no copay or coinsurance for up to 12 routine visits per year, excluding other chiropractic services. While some mental health and psychiatric services are covered with no copay or coinsurance, individual and group sessions for these services are not covered.
Preventive Services See details
Preventive services under DrElite-SFL (HMO) are partially covered with no copay and no coinsurance for covered benefits like fitness programs, health education, and kidney disease education. Sub-services that are not covered include annual physical exams, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
DrElite-SFL (HMO) provides hearing services with no copay and no coinsurance, including unlimited routine hearing exams and one fitting evaluation every two years. Prescription hearing aids are partially covered up to $1,000 every two years, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DrElite-SFL (HMO) with no copay, no coinsurance, and no deductible for covered care. This benefit includes one routine eye exam per year and up to $200 annually for eyewear such as glasses and contacts, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by DrElite-SFL (HMO) with no copay and no coinsurance for covered benefits like oral exams, cleanings, x-rays, fluoride, restorative care, periodontics, removable prosthodontics, and oral surgery. However, other diagnostic, other preventive, adjunctive general, endodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DrElite-SFL (HMO) with no copay, while associated Medicare Part B chemotherapy and other drugs require no copay and no coinsurance to 20% coinsurance. Covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance, with prior authorization and step therapy required for these benefits.
Dialysis Services See details
DrElite-SFL (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization and a referral are required.
Medical Equipment See details
Medical equipment is partially covered by DrElite-SFL (HMO) with no copay, though medical supplies are not covered and prior authorization is required. Covered benefits like durable medical equipment, prosthetics, and diabetic supplies feature no copay and range from no coinsurance to 20% coinsurance, while diabetic therapeutic shoes and inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
DrElite-SFL (HMO) diagnostic services are partially covered with no coinsurance and copays ranging from $0 to $75 for tests, while lab services are not covered. Radiological services require prior authorization and referrals, featuring outpatient X-rays with no copay but applicable coinsurance, diagnostic radiological services starting at no copay, and therapeutic radiological services with a copay and no coinsurance.
Home Health Services See details
Home Health Services are covered by DrElite-SFL (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DrElite-SFL (HMO) offers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. Under this benefit, some services are covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
DrElite-SFL (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $100 copay for days 21 through 100. Prior authorization is required and no prior three-day inpatient hospital stay is needed, but additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DrElite-SFL (HMO) partially covers other services, offering acupuncture and over-the-counter (OTC) items with no copay and no coinsurance, while meal benefits are not covered. Eligible members receive up to 20 acupuncture treatments per year with prior authorization, and a $30 monthly allowance for OTC items.
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