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DEVOTED DUAL 041 FL (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL 041 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 041 FL (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL 041 FL (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Flagler and Volusia Counties. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED DUAL 041 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 041 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 041 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 041 FL (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.20. 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 041 FL (HMO D-SNP) Medicare Advantage plan has an annual prescription drug deductible of $615. Under this plan, you will pay a 25% coinsurance for Tier 1 preferred generic, Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs when filled as a 1-month, 2-month, or 3-month supply at standard pharmacies or standard mail order. For Tier 5 specialty drugs, the plan charges a 25% coinsurance for a 1-month supply at standard pharmacies and standard mail order. Tier 6 select care drugs offer the most savings with no copay for 1-month, 2-month, or 3-month supplies through standard pharmacies and standard mail order services.
Additional Benefits
The DEVOTED DUAL 041 FL (HMO D-SNP) plan offers comprehensive medical coverage featuring no copay for primary care visits, preventive services, and home health care. Specialist visits, mental health services, and Medicare-covered dental care require a low $10 copay, while inpatient hospital stays have a $275 daily copay for days 1 through 5 and no copay for days 6 through 90. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. For extra benefits, the plan provides comprehensive dental services with no copay or coinsurance up to a $2,500 yearly limit, alongside a $400 annual allowance for eyewear with no copay. Members also receive a $50 quarterly allowance for over-the-counter items with no copay, and routine hearing exams are available for a $10 copay. While medical equipment has no copay, it does require a coinsurance ranging from 20% to 30%.
Inpatient Hospital See details
DEVOTED DUAL 041 FL (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring prior authorization and a $275 daily copay for days 1 through 5, followed by no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED DUAL 041 FL (HMO D-SNP) covers outpatient services with no coinsurance, featuring a $0 to $275 copay for outpatient hospital services and a $275 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require a $10 copay per session and no coinsurance.
Partial Hospitalization See details
DEVOTED DUAL 041 FL (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
DEVOTED DUAL 041 FL (HMO D-SNP) covers ambulance services with prior authorization, featuring a $0 to $350 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are not covered.
Emergency Services See details
DEVOTED DUAL 041 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 have no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with a $130 copay and no coinsurance for emergency or urgent care, and a $350 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED DUAL 041 FL (HMO D-SNP) offers primary care physician services with no copay and no coinsurance, while specialists, mental health, and podiatry services require a $10 copay and no coinsurance. Physical and occupational therapy have a $10 to $50 copay and no coinsurance, and chiropractic benefits are partially covered because other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED DUAL 041 FL (HMO D-SNP) with no copay and no coinsurance for covered options such as annual physicals, fitness benefits, and nutritional therapy. Uncovered sub-services include personal emergency response systems (PERS), in-home support, therapeutic massage, and caregiver support.
Hearing Services See details
Hearing services are partially covered by DEVOTED DUAL 041 FL (HMO D-SNP), which offers routine hearing exams for a $10 copay and no coinsurance, and up to two prescription hearing aids per year with a copay ranging from $399 to $699 and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered under this plan.
Vision Services See details
DEVOTED DUAL 041 FL (HMO D-SNP) partially covers vision services, offering one routine eye exam per year with a $0 to $10 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $400 annual maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED DUAL 041 FL (HMO D-SNP), requiring a $10 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for covered preventive and comprehensive services up to a $2,500 yearly maximum. While exams, cleanings, and major services like root canals and dentures are covered, other diagnostic services, other 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 041 FL (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a 0% to 20% coinsurance, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED DUAL 041 FL (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED DUAL 041 FL (HMO D-SNP) provides partially covered medical equipment with no copays, though prior authorization is required. Durable medical equipment requires 20% to 30% coinsurance, prosthetics and medical supplies have no coinsurance to 20% coinsurance, and diabetic supplies have no coinsurance to 30% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED DUAL 041 FL (HMO D-SNP) covers diagnostic services with no coinsurance and prior authorization, featuring no copay for labs and a $0 to $95 copay for procedures. Covered radiological services also require prior authorization, offering outpatient X-rays and diagnostic radiological services with no copay, and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
DEVOTED DUAL 041 FL (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED DUAL 041 FL (HMO D-SNP) covers Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED DUAL 041 FL (HMO D-SNP) covers skilled nursing facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED DUAL 041 FL (HMO D-SNP) partially covers other services, offering additional preventive services and up to $50 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and Dual Eligible SNPs with Highly Integrated Services are not covered under this benefit.
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