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Florida Complete Care-Duals VIP (HMO-POS D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Florida Complete Care-Duals VIP (HMO-POS D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Florida Complete Care-Duals VIP (HMO-POS D-SNP) in 2025, please refer to our full plan details page.
Florida Complete Care-Duals VIP (HMO-POS D-SNP) is a HMO-POS D-SNP plan offered by Independent Living Systems, LLC available for enrollment in 2025 to people living in Northern, Central and Southern Florida. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Florida Complete Care-Duals VIP (HMO-POS D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Florida Complete Care-Duals VIP (HMO-POS 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 Florida Complete Care-Duals VIP (HMO-POS 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 Florida Complete Care-Duals VIP (HMO-POS D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.30. 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 $590.00 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 combined Maximum Out-Of-Pocket cost of $3400.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $3400.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Florida Complete Care-Duals VIP (HMO-POS D-SNP) plan has a defined standard drug benefit. The plan has a deductible of $590.00. If you qualify for the low-income subsidy, you will pay $20.30. After you pay your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. Once you reach that amount, you will enter the next coverage phase. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Florida Complete Care-Duals VIP (HMO-POS D-SNP) plan provides coverage for a range of healthcare services. It includes coverage for inpatient and outpatient hospital services with a 20% coinsurance, and some services like primary care physician visits, and home health services have no coinsurance. Vision, hearing, and dental services are also covered, with varying coinsurance amounts and maximum benefit limits. This plan offers additional benefits such as ambulance services, emergency services, and medical equipment, all with a 20% coinsurance. The plan also covers home infusion services, dialysis, and skilled nursing facilities with coinsurance requirements. Additionally, the plan provides an over-the-counter (OTC) allowance and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, with prior authorization required. Additional days for inpatient hospital, non-Medicare-covered stays, and upgrades for acute care, as well as additional days and non-Medicare-covered stays for psychiatric care, are not covered.
Outpatient Services See details
Outpatient services include all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient substance abuse services. Outpatient hospital services and observation services have a 20% coinsurance, while ambulatory surgical center (ASC) services, individual sessions for outpatient substance abuse, and group sessions for outpatient substance abuse have a minimum coinsurance of 20% and a maximum coinsurance of 20%. Outpatient blood services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Florida Complete Care-Duals VIP (HMO-POS D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, as well as transportation services to plan-approved health-related locations. Ground and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Florida Complete Care-Duals VIP (HMO-POS D-SNP) plan. Emergency Services and Urgently Needed Services have a 20% coinsurance, with no copay. Worldwide Emergency Services are not covered.
Primary Care See details
Primary Care Physician Services are covered with no coinsurance, while Chiropractic Services are covered with 20% coinsurance and require prior authorization. Occupational Therapy, Physician Specialist Services, Individual and Group Sessions for Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, and Opioid Treatment Program Services are covered with 20% coinsurance. Routine Foot Care has 20% coinsurance and is limited to 6 visits per year. Additional Telehealth Benefits are covered with 0% to 20% coinsurance.
Preventive Services See details
Preventive Services are covered, but Annual Physical Exams, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following Welcome Visits are covered.
Hearing Services See details
Florida Complete Care-Duals VIP (HMO-POS D-SNP) covers hearing exams with a coinsurance of at most 20%, with a maximum plan benefit of $1000 every year, and covers routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Florida Complete Care-Duals VIP (HMO-POS D-SNP) plan covers vision services, including eye exams and eyewear. Eye exams have a 20% coinsurance, and eyewear, including contact lenses, has a 20% coinsurance. Upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services. Other dental services have a maximum benefit of $1095.00 every three months.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Diabetic Supplies have a 20% coinsurance, and Medical Supplies have a 20% coinsurance as well.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Florida Complete Care-Duals VIP (HMO-POS D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Florida Complete Care-Duals VIP (HMO-POS D-SNP) plan with no copay and no coinsurance, though authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered. Prior authorization is required for SNF services, and there is no copay or coinsurance.
Other Services See details
Other Services for Florida Complete Care-Duals VIP (HMO-POS D-SNP) includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $85.00 every month, and a meal benefit that requires prior authorization. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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