Powered by Q1Group LLC
Education and Decision Support Tools for the Medicare Community

2019 Medicare Advantage Plan Benefit Details for the AvMed Medicare Circle (HMO)

2019 Medicare Advantage Plan Details
Medicare Plan Name:AvMed Medicare Circle (HMO)
Location:Miami-Dade, Florida
Plan ID:H1016 - 023 - 0     Click to see other plans
Member Services:1-800-782-8633 TTY users 711
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
Email a copy of the AvMed Medicare Circle (HMO) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:$0
Annual Initial Coverage Limit (ICL):$4,000
Health Plan Type:Local HMO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,700
Additional Gap Coverage?Yes, some additional gap coverage.
Total Number of Formulary Drugs:3,147 drugsBrowse the AvMed Medicare Circle (HMO) Formulary
This plan has 5 drug tiers. See cost-sharing for all pharmacies and tiers
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:
Number of Drugs per
Plan's Pharmacy Search:http://www.avmed.org
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in Miami-Dade, Florida:283 members
Number of Members enrolled in this plan in (H1016 - 023):286 members
Plan’s Summary Star Rating: 4 out of 5 Stars.
Customer Service Rating: 5 out of 5 Stars.
Member Experience Rating: 3 out of 5 Stars.
Drug Cost Accuracy Rating: 4 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows:
Part C
Part D Base
Part D Supplemental
Monthly Premium with Extra Help Low-Income Subsidy (LIS): 100%
Monthly Part D Premium with LIS:$0.00$0.00$0.00$0.00
Total Monthly Premium with LIS (Parts C & D):$0.00$0.00$0.00$0.00
— Plan Health Benefits —
** Benefit Highlights **
Health plan deductible
• $0
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
• $6,700 In-network
Optional supplemental benefits
• No
Inpatient hospital coverage
• $0 per day for days 1 through 5
$0 per day for days 6 through 20
$0 per day for days 21 through 90
$0 per day for days 91 and beyond
Outpatient hospital coverage
• $175 per visit
Preventive care
• $0 copay
Other health plan deductibles?
In-Network:  No
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
In-Network:  No
Doctor visits
Primary:  $0 copay
Specialist:  $0 copay
Emergency care/Urgent care
Emergency:  $90 per visit (always covered)
Urgent care:  $10 per visit (always covered)
Skilled Nursing Facility
• $0 per day for days 1 through 20
$160 per day for days 21 through 62
$0 per day for days 63 through 100
Ground ambulance
• $145
• $0 copay
Wellness programs (e.g., fitness, nursing hotline)
• Covered
Routine eye exam:  $0 copay
Other:  Not covered
Contact lenses:  $0 copay
Eyeglasses (frames and lenses):  $0 copay
Eyeglass frames:  Not covered
Eyeglass lenses:  Not covered
Upgrades:  Not covered
Mental health services
Inpatient hospital - psychiatric:  $150 per day for days 1 through 9
$0 per day for days 10 through 90
Outpatient group therapy visit with a psychiatrist:  $15
Outpatient individual therapy visit with a psychiatrist:  $15
Outpatient group therapy visit:  $15
Outpatient individual therapy visit:  $15
Rehabilitation services
Occupational therapy visit:  $0 copay
Physical therapy and speech and language therapy visit:  $0 copay
Foot care (podiatry services)
Foot exams and treatment:  $5
Routine foot care:  $5
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):  10% per item
Prosthetics (e.g., braces, artificial limbs):  $0 copay
Diabetes supplies:  $0 copay
Medicare Part B drugs
Chemotherapy:  10-20%
Other Part B drugs:  10-20%
** Benefits Services **
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:  $0 copay
Lab services:  $0 copay
Diagnostic radiology services (e.g., MRI):  0-20%
Outpatient x-rays:  $0 copay
Hearing exam:  $0 copay
Fitting/evaluation:  $0 copay
Hearing aids:  $0 copay
Preventive dental
Oral exam:  $0-25
Cleaning:  $0-45
Fluoride treatment:  Not covered
Dental x-ray(s):  $0-35
Comprehensive dental
Non-routine services:  $0-195
Diagnostic services:  $0-40
Restorative services:  $22-530
Endodontics:  $22-535
Periodontics:  $0-435
Extractions:  $45-175
Prosthodontics, other oral/maxillofacial surgery, other services:  $0-700

Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.