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Devoted EXTRA Florida (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted EXTRA Florida (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted EXTRA Florida (HMO) in 2025, please refer to our full plan details page.
Devoted EXTRA Florida (HMO) is a HMO 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 4.5 out of 5 stars in 2025.
It's important to know that Devoted EXTRA Florida (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Devoted EXTRA Florida (HMO).
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 EXTRA Florida (HMO), 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 $590.00 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 EXTRA Florida (HMO) plan has a $590 deductible for prescription drugs. After the deductible, you will pay for your prescriptions based on the drug tier and the pharmacy you use. For preferred generic drugs, you will have no copay at standard and mail order pharmacies. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase.
Additional Benefits
The Devoted EXTRA Florida (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays for different services, such as $275 for inpatient hospital days 1-5. The plan also covers primary care, preventive, hearing, vision, and dental services, with copays for exams and specific services. There are also additional benefits such as ambulance, emergency, and home health services, with some requiring prior authorization, and additional copays or coinsurance may apply depending on the service.
Inpatient Hospital See details
Inpatient Hospital services, including those not usually covered by Medicare, are covered, with a copay of $275 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric services are covered with a copay of $275 for days 1-5 and no copay for days 6-90, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Devoted EXTRA Florida (HMO) plan. Outpatient Hospital Services have a copay between $0 and $275, while Observation Services have a $275 copay. Ambulatory Surgical Center (ASC) Services have no copay, and both individual and group sessions for outpatient substance abuse have a copay of $10. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted EXTRA Florida (HMO) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted EXTRA Florida (HMO) plan, but require prior authorization. Ground ambulance services have a copay between $0 and $350, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services for the Devoted EXTRA Florida (HMO) plan include a $125 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $45, with no coinsurance. Worldwide Emergency Services, Worldwide Urgent Coverage, and Worldwide Emergency Coverage have varying copays and coinsurance amounts depending on the specific service.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services has a $10 copay, Occupational Therapy Services has a copay between $10 and $45, Physician Specialist Services has a $10 copay, Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services have a $10 copay, Physical Therapy and Speech-Language Pathology Services have a copay between $10 and $50, Additional Telehealth Benefits have a copay between $0 and $10, and Opioid Treatment Program Services have a $10 copay. However, Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, and additional preventive services. The plan also covers Health Education, Weight Management Programs, Alternative Therapies, Nutritional/Dietary Benefit, Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing services include coverage for routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $699, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $10 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $1250 per year.
Dental Services See details
The Devoted EXTRA Florida (HMO) plan covers dental services, including Medicare dental services with a $10 copay, and other services with a $1,250 maximum per year. Oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatments, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B insulin drugs, are covered by Devoted EXTRA Florida (HMO). For Medicare Part B insulin drugs, there is a $35 copay and 20% coinsurance, while other Medicare Part B drugs may have up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted EXTRA Florida (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 25% coinsurance and no copay, Prosthetics/Medical Supplies with coinsurance for Medicare-covered items and no copay, and Diabetic Equipment. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $95, and Lab Services with no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted EXTRA Florida (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires prior authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted EXTRA Florida (HMO) plan, but some services are not covered. The plan has a copay for Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted EXTRA Florida (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Devoted EXTRA Florida (HMO) plan's "Other Services" benefit does not cover acupuncture, over-the-counter items, meal benefits, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. Some services are covered, including $0 preventive services.
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