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DEVOTED DUAL 022 FL (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL 022 FL (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED DUAL 022 FL (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL 022 FL (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Osceola, Seminole, and Orange Counties. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED DUAL 022 FL (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED DUAL 022 FL (HMO 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 DEVOTED DUAL 022 FL (HMO 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 DEVOTED DUAL 022 FL (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $615.00 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 Maximum Out-Of-Pocket cost of $3900.00 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 DEVOTED DUAL 022 FL (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tiers 1 through 4, which cover preferred generic, generic, preferred brand, and non-preferred drugs, you will pay a 25% coinsurance for one-month, two-month, and three-month supplies at standard pharmacies and standard mail-order. Tier 5 specialty drugs also carry a 25% coinsurance for a one-month supply through standard pharmacies and standard mail-order. For Tier 6 select care drugs, there is no copay for one-month, two-month, or three-month supplies filled at standard pharmacies or standard mail-order. This plan structure provides clear cost expectations for your medication needs to help you manage your healthcare budget.
Additional Benefits
The DEVOTED DUAL 022 FL (HMO D-SNP) offers comprehensive medical coverage featuring no copays for primary care visits, home health services, and preventive care. For specialist visits and Medicare-covered dental services, you will pay a low $5 copay, while inpatient hospital stays require a $175 daily copay for the first five days and no copay for days six through 90. Emergency room services carry a $150 copay, which is waived if you are admitted, and urgent care visits range from no copay to $45. This plan also includes valuable diagnostic, vision, and hearing benefits, featuring no copays for lab services and outpatient X-rays, alongside eyewear coverage up to a $400 annual limit with no copay. Prescription hearing aids are covered with copays ranging from $399 to $699, and other covered dental services are available with no copay up to a $2,500 yearly maximum. Additionally, members receive a $50 over-the-counter allowance every three months with no copay to help cover everyday health items.
Inpatient Hospital See details
DEVOTED DUAL 022 FL (HMO D-SNP) covers inpatient hospital acute and psychiatric stays with no coinsurance, requiring a $175 daily copay for days 1 through 5 and no copay for days 6 through 90. Unlimited additional days are covered for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED DUAL 022 FL (HMO D-SNP) covers outpatient services with no coinsurance, featuring ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a copay of $0 to $175 (including a $175 copay per stay for observation services), while outpatient substance abuse services have a $5 copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the DEVOTED DUAL 022 FL (HMO D-SNP) plan with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED DUAL 022 FL (HMO D-SNP) covers ambulance services with prior authorization, featuring ground ambulance services that require coinsurance and range from no copay to a $300 copay, and air ambulance services that require a 20% coinsurance and a copay. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by DEVOTED DUAL 022 FL (HMO D-SNP) with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, while urgent care ranges from no copay to a $45 copay with no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 limit with a $150 copay and no coinsurance, while worldwide emergency transportation requires a $300 copay and 20% coinsurance.
Primary Care See details
DEVOTED DUAL 022 FL (HMO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist, mental health, and routine podiatry visits require a $5.00 copay and no coinsurance. Chiropractic services are partially covered, excluding other chiropractic services, with a $5.00 copay and no coinsurance for up to 6 routine visits per year. Physical and occupational therapy services feature a copay ranging from $5.00 to $50.00 and no coinsurance.
Preventive Services See details
Preventive services are covered by DEVOTED DUAL 022 FL (HMO D-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness programs, weight management, and home safety devices, while sub-services such as in-home support and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED DUAL 022 FL (HMO D-SNP), featuring routine hearing exams for a $5.00 copay and no coinsurance, and up to two prescription hearing aids per year with no coinsurance and a $399.00 to $699.00 copay. However, over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED DUAL 022 FL (HMO D-SNP) partially covers vision services, offering one annual routine eye exam with a $0 to $5 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $400 annual limit for contacts, glasses, and upgrades.
Dental Services See details
DEVOTED DUAL 022 FL (HMO D-SNP) dental services are partially covered, featuring a $5 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,500 annual maximum. Other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED DUAL 022 FL (HMO D-SNP) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED DUAL 022 FL (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is covered under the DEVOTED DUAL 022 FL (HMO D-SNP) plan with no copays, though prior authorization is required. Durable medical equipment has a 20% to 30% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with diabetic supplies ranging from no coinsurance to 30% coinsurance while therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED DUAL 022 FL (HMO D-SNP) covers diagnostic and radiological services, with prior authorization required for these benefits. There is no copay or coinsurance for lab services, outpatient X-rays, and diagnostic radiological services, though diagnostic procedures and tests range from a $0 to $95 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED DUAL 022 FL (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Some Cardiac Rehabilitation Services are covered under DEVOTED DUAL 022 FL (HMO D-SNP) with no coinsurance and a $5 copay, although cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED DUAL 022 FL (HMO D-SNP) with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other Services are partially covered by DEVOTED DUAL 022 FL (HMO D-SNP), offering no copay and no coinsurance for additional preventive services and over-the-counter (OTC) items up to $50 every three months. Acupuncture and meal benefits are not covered under this plan.
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