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DEVOTED CORE 057 FL (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 057 FL (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 057 FL (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 057 FL (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 5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 057 FL (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 CORE 057 FL (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 CORE 057 FL (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 no drug deductible. Your prescription medication coverage will start immediately.
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 CORE 057 FL (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately with no upfront costs. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order for one-, two-, or three-month supplies. For brand-name and specialty prescriptions, cost-sharing is based on coinsurance rather than flat copays. Standard pharmacy and standard mail-order fills require a 20% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs are subject to a 33% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CORE 057 FL (HMO) plan offers robust everyday coverage with no copay and no coinsurance for primary care visits, preventive services, and routine annual physicals. Specialist visits and mental health services require a low $10 copay, while emergency room visits carry a $130 copay that is waived if you are admitted. Additionally, members benefit from dental coverage up to a $3,500 annual limit and a $400 annual allowance for eyewear with no copay. For hospital care, inpatient stays require a $275 daily copay for the first five days and no copay for days six through 90, with no coinsurance. Skilled nursing facility stays feature no copay for the first 20 days and a $218 daily copay for days 21 through 100. This plan also includes valuable extras like a $100 quarterly over-the-counter allowance and prescription hearing aid coverage with copays ranging from $399 to $699.
Inpatient Hospital See details
DEVOTED CORE 057 FL (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $275 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute days are covered, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CORE 057 FL (HMO) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $275, observation services carry a $275 copay per stay, and outpatient substance abuse sessions cost a $10 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CORE 057 FL (HMO) with a $60.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED CORE 057 FL (HMO) partially covers ambulance and transportation services, requiring prior authorization for ambulance services which carry a copay ranging from no copay to $350 for ground transport and a 20% coinsurance for air transport. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 057 FL (HMO) 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 require no copay to a $45 copay with no coinsurance, while worldwide emergency services are covered up to a $25,000 limit with copays ranging from $130 to $350 and up to 20% coinsurance.
Primary Care See details
Primary care services under DEVOTED CORE 057 FL (HMO) are covered with no copay and no coinsurance for primary care visits, while specialists and mental health services require a $10 copay and no coinsurance. Physical and occupational therapy have a $10 to $50 copay with no coinsurance, but podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive services under DEVOTED CORE 057 FL (HMO) are covered with no copay and no coinsurance, including annual physicals, kidney disease education, and glaucoma screenings. Additional preventive benefits are partially covered with no copay and no coinsurance for fitness programs, nutritional counseling, and home safety devices, while services like therapeutic massage, in-home support, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED CORE 057 FL (HMO) offers partially covered hearing services, which include a $10 copay and no coinsurance for one routine hearing exam per year. Prescription hearing aids are covered for up to two devices per year with a copay ranging from $399 to $699 and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
DEVOTED CORE 057 FL (HMO) provides partially covered 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 maximum annual benefit for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 057 FL (HMO) up to a $3,500 annual limit, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental has a $10 copay and no coinsurance, while other covered services require no copay and range from no coinsurance to 50% coinsurance.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CORE 057 FL (HMO) with no copay, while associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance. Covered Medicare Part B insulin has a $35 copay and 0% to 20% coinsurance, which does not count toward the plan-level deductible.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CORE 057 FL (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
DEVOTED CORE 057 FL (HMO) covers medical equipment with no copay, with coinsurance ranging from no coinsurance up to 50% and prior authorization required. The benefit is partially covered, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 057 FL (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures have a $0 to $95 copay and no coinsurance, lab services and outpatient X-rays feature no copays, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CORE 057 FL (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by DEVOTED CORE 057 FL (HMO) with no coinsurance and a $10 copay, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered in practice.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 057 FL (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a three-day inpatient hospital stay is not required prior to admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under the DEVOTED CORE 057 FL (HMO) plan are partially covered, offering additional preventive services and Over-the-Counter (OTC) items with no copay and no coinsurance, including a $100 quarterly OTC allowance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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