Doctors HealthCare Plans, Inc. Your Health, Our Commitment
 2020 Ponce de Leon Blvd, Suite PH 1, Coral Gables, FL 33134   
  

2021 MEDICARE ADVANTAGE PLANS

Doctors HealthCare Plans, Inc., offers seven distinct plan options to accommodate your unique coverage needs. All plans provide the same benefits as traditional Medicare as well as additional benefits such as:

  • Prescription Drug Coverage
  • Dental Services
  • Vision Benefits
  • Hearing Benefit
  • Transportation
  • Fitness Plan
  • Over the Counter Medications (OTC)

All plans have a Point-of-Service* benefit without a referral. This benefit allows you to access out-of-network specialists for office visits in Miami-Dade County up to your plan’s specific benefit amount. A prior authorization is required. The following specialties are excluded: Pain Management, Dermatology, Oncology, and Behavioral Health.

All plans provide coverage for Durable Medical Equipment.  The list of preferred vendors and manufacturers for durable medical equipment (DME) is attached. Click here to see listCovered DME items include but are not limited to: oxygen equipment and supplies, wheelchairs, walkers, powered mattress systems, crutches, diabetic supplies, speech generating devices, IV infusion pumps, and nebulizers.

To enroll, you must be entitled to Medicare Part A, enrolled in Medicare Part B, and reside in Miami-Dade County. For Special Needs Plans (SNP), certain additional requirements apply.

HOW TO REACH US
If you are a member,
please call Member Services at:
786-460-3427
Toll Free: 1-833-342-7463, TTY 711,
7 days a week, 8:00 a.m. to 8:00 p.m.
If you are not a member,
please call a Licensed Sales Agent at 786-420-3427
Toll Free: 833-639-3427, TTY 711,
7 days a week 8:00 a.m. to 6:00 p.m.

DrMax (HMO-POS)

Looking for richer benefits and better prescription drug coverage? This plan may be for you!

  1. Summary of Benefits (SB) EnglishSpanish
  2. Formulary / Drug List
  3. Over the Counter (OTC) Catalog. You may conveniently order:
    • By calling: 1-888-628-2770; TTY: 1-877-672-2688, Monday to Friday, 9 a.m. to 8 p.m. E.S.T.
    • Online
  4. Evidence of Coverage (EOC) English / Spanish
  5. Annual Notice of Change for 2021 (ANOC) English / Spanish
DrMax (HMO-POS)
Monthly Plan Premium $0
Primary Care / Specialists Visits $0 per visit
Inpatient Hospital Stays $0 per stay
Acupuncture $0 copayment for up to 20 treatments a year
Part D Prescription Drug Coverage

Deductible: $0

Copayment/Coinsurance during the Initial Coverage Stage, for a 30-day supply from a retail or mail order pharmacy:

  • Drug Tier 1: $0
  • Drug Tier 2: $0
  • Drug Tier 3: $0
  • Drug Tier 4: $45
  • Drug Tier 5: 33%

Initial Coverage Limit: $6,000

DrPlus (HMO-POS SNP)

Do you have both Medicare and Medicaid? This plan may be for you!

  1. Summary of Benefits (SB) English / Spanish
  2. Formulary / Drug List
  3. Over the Counter (OTC) Catalog. You may conveniently order:
    • By calling: 1-888-628-2770; TTY: 1-877-672-2688, Monday to Friday, 9 a.m. to 8 p.m. E.S.T.
    • Online
  4. Evidence of Coverage (EOC) English / Spanish
  5. Annual Notice of Change for 2021 (ANOC) English / Spanish
DrPlus (HMO-POS SNP)
Monthly Plan Premium $0-$30.80
Part B premium may be covered through your State Medicaid Program.
Primary Care / Specialists Visits $0 per visit
Inpatient Hospital Stays $0 per stay
Acupuncture $0 copayment for up to 20 treatments a year
Part D Prescription Drug Coverage

Deductible: $0

Copayment/Coinsurance during the Initial Coverage Stage, for a 30-day supply from a retail or mail order pharmacy:

  • Drug Tier 1: $0
  • Drug Tier 2: $0
  • Drug Tier 3: $0
  • Drug Tier 4: $35
  • Drug Tier 5: 33%

Initial Coverage Limit: $6,000

*Must be a Qualified Medicare Beneficiary (QMB, QMB+), Specified Low-Income Medicare Beneficiary (SLMB, SLMB+), Full Benefit Dual Eligible (FBDE), Qualified Individual (QI) or Qualified Disabled and Working Individual (QDWI). DrPlus (HMO POS SNP) is sponsored by Doctors HealthCare Plans, Inc. and the State of Florida Agency for Health Care Administration. DrPlus (HMO-POS SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2021 based on a review of DrPlus (HMO POS SNP) Model of Care.

DrCare (HMO-POS SNP)

Are you living with Chronic Heart Failure (CHF)? This plan may be for you!

  1. Summary of Benefits (SB) English / Spanish
  2. Formulary / Drug List
  3. Over the Counter (OTC) Catalog. You may conveniently order:
    • By calling: 1-888-628-2770; TTY: 1-877-672-2688, Monday to Friday, 9 a.m. to 8 p.m. E.S.T.
    • Online
  4. Evidence of Coverage (EOC) English / Spanish
  5. Annual Notice of Change for 2021 (ANOC) English / Spanish 
DrCare (HMO-POS SNP)
Monthly Plan Premium $0
Primary Care / Specialists Visits $0 per visit
Inpatient Hospital Stays $0 per stay
Acupuncture $0 copayment for up to 20 treatments a year
Part D Prescription Drug Coverage

Deductible: $0

Copayment/Coinsurance during the Initial Coverage Stage, for a 30-day supply from a retail or mail order pharmacy:

  • Drug Tier 1: $0
  • Drug Tier 2: $0
  • Drug Tier 3: $10
  • Drug Tier 4: $40
  • Drug Tier 5: 33%

Initial Coverage Limit: $5,000

DrCare (HMO-POS SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2021 based on a review of DrCare (HMO-POS SNP) Model of Care.

DrExtra (HMO- POS SNP)

Are you living with Diabetes Mellitus? This plan may be for you!

  1. Summary of Benefits (SB) English / Spanish
  2. Formulary / Drug List
  3. Over the Counter (OTC) Catalog. You may conveniently order:
    • By calling: 1-888-628-2770; TTY: 1-877-672-2688, Monday to Friday, 9 a.m. to 8 p.m. E.S.T.
    • Online
  4. Evidence of Coverage (EOC) English / Spanish
  5. Annual Notice of Change for 2021 (ANOC) English / Spanish
DrExtra (HMO-POS SNP)
Monthly Plan Premium $0
Primary Care / Specialists Visits $0 per visit
Inpatient Hospital Stays $0 per stay
Acupuncture $0 copayment for up to 20 treatments a year
Part D Prescription Drug Coverage

Deductible: $0

Copayment/Coinsurance during the Initial Coverage Stage, for a 30-day supply from a retail or mail order pharmacy:

  • Drug Tier 1: $0
  • Drug Tier 2: $0
  • Drug Tier 3: $10
  • Drug Tier 4: $40
  • Drug Tier 5: 33%

Initial Coverage Limit: $5,000

DrExtra (HMO-POS SNP) has been approved by the National Committee for Quality Assurance (NCQA) to operate as a Special Needs Plan (SNP) until December 31, 2021 based on a review of DrExtra (HMO POS SNP) Model of Care.

DrValue (HMO-POS)

Would you like to put more money in your pocket? This plan may be for you!

  1. Summary of Benefits (SB) English / Spanish
  2. Formulary / Drug List
  3. Over the Counter (OTC) Catalog.  You may conveniently order:
    • By calling: 1-888-628-2770; TTY: 1-877-672-2688, Monday to Friday, 9 a.m. to 8 p.m. E.S.T.
    • Online
  4. Evidence of Coverage (EOC) English / Spanish
  5. Annual Notice of Change for 2021 (ANOC) English / Spanish
DrValue (HMO-POS)
Return of Part B Premium
Up to $100
Monthly Plan Premium $0
Primary Care / Specialists Visits $0 per visit
Inpatient Hospital Stays.
Inpatient Hospital Stays

Inpatient Hospital Stays:
$0 per stay Days 1-4
$85 per stay Days 5-90
$0 per stay Days 91+
OR until maximum out of pocket is reached

Inpatient Hospital Psychiatric Stays:
$100 per stay Days 1-5
$0 per stay Days 6-90+
OR until maximum out of pocket is reached

Part D Prescription Drug Coverage

Deductible: $0

Copayment/Coinsurance during the Initial Coverage Stage, for a 30-day supply from a retail or mail order pharmacy:
• Drug Tier 1: $0
• Drug Tier 2: $0
• Drug Tier 3: $45
• Drug Tier 4: $90
• Drug Tier 5: 33%

Initial Coverage Limit: $4,130

DrFirst (HMO-POS)

Would you like a Plan with EXTRA benefits?  This plan may be for you!

  1. Summary of Benefits (SB) English / Spanish
  2. Formulary / Drug List
  3. Over the Counter (OTC) Catalog. You may conveniently order:
    • By calling: 1-888-628-2770; TTY: 1-877-672-2688, Monday to Friday, 9 a.m. to 8 p.m. E.S.T.
    • Online
  4. Evidence of Coverage (EOC) English / Spanish
DrFirst (HMO-POS)
Monthly Plan Premium

$0-$30.80
Premiums may be reduced or paid for by “EXTRA Help”.

Primary Care / Specialists Visits $0 per visit
Inpatient Hospital Stays $0 per stay
Acupuncture
$0 copayment for up to 20 treatments a year
Part D Prescription Drug Coverage

Deductible: $445 (for Tiers 3-5)

If you receive “EXTRA Help” from Medicare, your cost for prescription drugs may be lower.

Copayment/Coinsurance during the Initial Coverage Stage, for a 30-day supply from a retail or mail order pharmacy:

  • Drug Tier 1: $0
  • Drug Tier 2: $0
  • Drug Tier 3: 25%
  • Drug Tier 4: 25%
  • Drug Tier 5: 25%

Initial Coverage Limit: $4,130

DrChoice (HMO-POS)

Would you like a plan with a defined PCP Network that provides EXTRA benefits?  This plan may be for you! 

  1. Summary of Benefits (SB) English / Spanish
  2. Formulary/Drug List
  3. Over the Counter (OTC) Catalog. You may conveniently order:
    • By calling: 1-888-628-2770; TTY: 1-877-672-2688, Monday to Friday, 9 a.m. to 8 p.m. E.S.T.
    • Online
  4. Evidence of Coverage (EOC) English / Spanish
DrChoice (HMO-POS)
Monthly Plan Premium

$0-$30.80
Premiums may be reduced or paid for by “EXTRA Help”.

Primary Care / Specialists Visits $0 per visit
Inpatient Hospital Stays $0 per stay
Acupuncture $0 copayment for up to 20 treatments a year
Part D Prescription Drug Coverage

Deductible: $445 (for Tiers 3-5)

If you receive “EXTRA Help” from Medicare, your cost for prescription drugs may be lower.

Copayment/Coinsurance during the Initial Coverage Stage, for a 30-day supply from a retail or mail order pharmacy:

  • Drug Tier 1: $0
  • Drug Tier 2: $0
  • Drug Tier 3: 25%
  • Drug Tier 4: 25%
  • Drug Tier 5: 25%

Initial Coverage Limit: $4,130

Reward Program

Up to $100 quarterly based on completion of identified health activities. (English / Spanish)

Personal/Respite Care Home health services that include personal/respite care to complete activities of daily living.

*Out-of-network/non-contracted providers are under no obligation to treat Doctors HealthCare Plans members, except in emergency situations. Please call Member Services or see your Evidence of Coverage for more information, including the cost sharing and maximum amount of coverage that applies to out-of-network services.

H4140_DHCPWS2021_M
Last Updated: 11/23/2020

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