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DEVOTED DUAL 039 FL (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL 039 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 039 FL (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL 039 FL (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Brevard, Indian River, Martin, St. Lucie Counties. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED DUAL 039 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 039 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 039 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 039 FL (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $3.90. 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 $4900.00 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 039 FL (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 through Tier 4 drugs, which include generic and preferred brand medications, members pay a 25% coinsurance for one-month, two-month, and three-month supplies filled at standard pharmacies or standard mail order. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply through standard networks. Additionally, Tier 6 select care drugs are fully covered with no copay for up to a three-month supply at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED DUAL 039 FL (HMO D-SNP) offers comprehensive healthcare coverage with no copay and no coinsurance for primary care visits, home health services, and preventive care. For inpatient hospital stays, members pay a $175 copay per day for the first six days and no copay for days seven through 90. Specialist visits and outpatient therapies are highly affordable, with copays ranging from no copay to $50 and no coinsurance. This plan also features valuable supplemental benefits, including dental coverage with no copay up to a $2,500 annual limit and eyewear coverage with no copay up to $400 yearly. Members benefit from no copay for over-the-counter items up to a $50 quarterly allowance, while routine eye and hearing exams require low copays up to $15. Durable medical equipment is covered with no copay, though coinsurance ranges from 20% to 30%.
Inpatient Hospital See details
DEVOTED DUAL 039 FL (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $175 copay per day for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
DEVOTED DUAL 039 FL (HMO D-SNP) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services have a copay of $0 to $175, observation services cost a $175 copay per stay, and outpatient substance abuse sessions require a $15 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED DUAL 039 FL (HMO D-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
DEVOTED DUAL 039 FL (HMO D-SNP) covers ground ambulance services with coinsurance and a copay ranging from no copay to $350.00, while air ambulance services require a 20% coinsurance and a copay. Transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED DUAL 039 FL (HMO D-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature a copay ranging from no copay to $45 with no coinsurance, and worldwide emergency services are covered up to $25,000 with copays up to $350 and up to 20% coinsurance.
Primary Care See details
DEVOTED DUAL 039 FL (HMO D-SNP) provides primary care physician services with no copay and no coinsurance, while chiropractic services are not covered. Other covered benefits, including specialist visits, physical and occupational therapy, podiatry, psychiatric, and mental health services, require copays ranging from $0 to $50 and no coinsurance.
Preventive Services See details
DEVOTED DUAL 039 FL (HMO D-SNP) offers partially covered preventive services with no copay and no coinsurance, including annual physical exams, fitness benefits, and alternative therapies. However, several specific sub-services are not covered under this plan, such as personal emergency response systems (PERS), in-home safety assessments, medical nutrition therapy, and therapeutic massage.
Hearing Services See details
Hearing services are partially covered by DEVOTED DUAL 039 FL (HMO D-SNP), offering routine hearing exams with a $15 copay and no coinsurance, and fitting evaluations. While up to two prescription hearing aids are covered per year with a $399 to $699 copay and no coinsurance, OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED DUAL 039 FL (HMO D-SNP), as other eye exam services are not covered. Routine eye exams are available with a $0 to $15 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and no deductible up to a $400 annual limit.
Dental Services See details
DEVOTED DUAL 039 FL (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with a $15 copay and no coinsurance, and other covered preventive and comprehensive services with no copay and no coinsurance up to a $2,500 annual maximum. Sub-services not covered under this plan include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED DUAL 039 FL (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED DUAL 039 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
DEVOTED DUAL 039 FL (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment requires 20% to 30% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with no coinsurance to 30% coinsurance on diabetic supplies, while therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED DUAL 039 FL (HMO D-SNP) covers diagnostic and radiological services with prior authorization required. Lab services and outpatient X-rays feature no copay, diagnostic tests have no coinsurance and a $0 to $95 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the DEVOTED DUAL 039 FL (HMO D-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered by DEVOTED DUAL 039 FL (HMO D-SNP) with no coinsurance and require prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED DUAL 039 FL (HMO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required and no prior three-day hospital stay is needed, though additional days beyond the 100-day Medicare limit are not covered.
Other Services See details
DEVOTED DUAL 039 FL (HMO D-SNP) partially covers other services, providing over-the-counter (OTC) items and additional preventive services with no copay and no coinsurance. OTC items are covered up to $50 every three months, but acupuncture, meal benefits, and highly integrated services are not covered.
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