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DEVOTED DUAL 043 FL (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL 043 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 043 FL (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL 043 FL (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Escambia, Santa Rosa Counties. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED DUAL 043 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 043 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 043 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 043 FL (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $6700.00 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 043 FL (HMO D-SNP) Medicare 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 1-month, 2-month, or 3-month supplies filled at standard pharmacies or standard mail order. Tier 5 specialty drugs also carry a 25% coinsurance for a 1-month supply through standard pharmacies and standard mail order. For Tier 6 select care drugs, there is no copay for 1-month, 2-month, or 3-month supplies at standard pharmacies and standard mail order. This structured coverage helps beneficiaries of the DEVOTED DUAL 043 FL (HMO D-SNP) plan manage their prescription medication costs effectively.
Additional Benefits
The DEVOTED DUAL 043 FL (HMO D-SNP) plan offers affordable coverage for core medical services, featuring no copays or coinsurance for primary care visits, home health care, and routine preventive services. For hospital stays, members pay no coinsurance, with inpatient care requiring a $275 daily copay for the first six days and no copay for additional days. Emergency room visits carry a $130 copay, which is waived if admitted, while outpatient hospital services range from no copay up to a $375 copay. This plan also provides valuable supplemental benefits, including preventive and comprehensive dental care with no copay up to a $2,000 annual limit, and eyewear covered up to a $400 yearly maximum. Hearing exams require a $40 copay, while up to two prescription hearing aids per year are available with copays ranging from $399 to $699. Additionally, members receive a $50 quarterly allowance for over-the-counter items and pay no copays for medical equipment, though durable medical equipment requires a 20% to 30% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DEVOTED DUAL 043 FL (HMO D-SNP) with no coinsurance, requiring a $275 daily copay for days 1 through 6 and no copay for days 7 through 90 per stay. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED DUAL 043 FL (HMO D-SNP) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services require a copay of $0 to $375 (including a $275 copay per stay for observation services), and outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED DUAL 043 FL (HMO D-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED DUAL 043 FL (HMO D-SNP) covers ambulance services with prior authorization, requiring a copay ranging from no copay to $295 plus coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED DUAL 043 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 range from no copay to a $45 copay with no coinsurance, while worldwide emergency services are covered up to $25,000 with varying copays and a 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED DUAL 043 FL (HMO D-SNP) covers primary care physician services and select telehealth benefits with no copay and no coinsurance. Specialist visits, physical and occupational therapies, podiatry, and mental health services are covered with copays ranging from $0 to $50 and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED DUAL 043 FL (HMO D-SNP) with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and home safety devices. Some sub-services are not covered under this plan, including in-home support, personal emergency response systems (PERS), counseling services, and therapeutic massages.
Hearing Services See details
DEVOTED DUAL 043 FL (HMO D-SNP) partially covers hearing services, offering hearing exams for a $40 copay and no coinsurance, and up to two prescription hearing aids per year for a copay of $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.
Vision Services See details
DEVOTED DUAL 043 FL (HMO D-SNP) provides partially covered vision services, including one routine eye exam per year with a $0 to $40 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is also covered with no copay, no coinsurance, and no deductible, up to a $400 yearly maximum allowance for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
DEVOTED DUAL 043 FL (HMO D-SNP) partially covers dental services, offering Medicare-covered dental with a $40 copay and no coinsurance, and other covered preventive and comprehensive dental services with no copay and no coinsurance up to a $2,000 annual maximum. However, other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED DUAL 043 FL (HMO D-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, insulin, and other drugs, require no coinsurance to 20% coinsurance, with insulin drugs also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under DEVOTED DUAL 043 FL (HMO D-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED DUAL 043 FL (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment carries 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 diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED DUAL 043 FL (HMO D-SNP) with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic procedures and tests range from a $0 to $95 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED DUAL 043 FL (HMO D-SNP) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
DEVOTED DUAL 043 FL (HMO D-SNP) covers cardiac rehabilitation services with no copay and no coinsurance, meaning some services are covered, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED DUAL 043 FL (HMO D-SNP) with no coinsurance and without requiring a prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond Medicare coverage are not covered.
Other Services See details
DEVOTED DUAL 043 FL (HMO D-SNP) partially covers other services, offering additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance, up to a $50 quarterly limit for OTC items. Acupuncture, meal benefits, and highly integrated services for dual eligible SNPs are not covered under this benefit.
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