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DEVOTED CORE 058 FL (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 058 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 058 FL (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 058 FL (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Greater Tampa Bay. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 058 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 058 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 058 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 $3900.00 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 058 FL (HMO) Medicare plan features a $0 drug deductible, meaning your prescription coverage begins immediately with no upfront costs. Under this plan, there is no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications filled at standard pharmacies or through standard mail order for any supply duration. This makes managing everyday health needs highly affordable and predictable. For brand-name and specialty prescriptions, costs vary depending on the drug tier and supply length. Tier 3 (Preferred Brand) drugs have a $47 copay for a one-month supply, with standard mail order offering savings on a three-month supply at $117.50. Tier 4 (Non-Preferred) drugs require a 25% coinsurance, while Tier 5 (Specialty) medications have a 33% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CORE 058 FL (HMO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay for primary care visits and a low $5 copay for specialists. Inpatient hospital stays require a $175 daily copay for the first five days and no copay thereafter, while emergency room visits have a $150 copay that is waived upon admission. Additionally, routine preventive services, home health care, and lab services are fully covered with no copay or coinsurance. This plan also provides excellent dental, vision, and hearing benefits, including a $3,500 annual dental maximum and a $400 annual allowance for eyewear with no copay. Members can take advantage of a $100 quarterly over-the-counter allowance with no copay, alongside routine hearing exams and low-cost hearing aids. Durable medical equipment and dialysis services are also covered, typically requiring coinsurance with no copay.
Inpatient Hospital See details
DEVOTED CORE 058 FL (HMO) covers inpatient hospital services with no coinsurance, requiring a $175 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional days are covered for acute care.
Outpatient Services See details
DEVOTED CORE 058 FL (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services have a $0 to $175 copay (observation services are $175 per stay) and outpatient substance abuse sessions have a $5 copay, all with no coinsurance.
Partial Hospitalization See details
DEVOTED CORE 058 FL (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
DEVOTED CORE 058 FL (HMO) covers ambulance services with prior authorization, requiring a copay of no copay to $300 and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. While some transportation services are covered, trips to plan-approved health-related locations and any other health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 058 FL (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to a $25,000 lifetime maximum with a $150 copay (no coinsurance) for emergency or urgent care and a $300 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 058 FL (HMO) offers primary care physician services with no copay and no coinsurance, while specialist, psychiatric, and mental health services require a $5 copay and no coinsurance. Physical, occupational, and speech therapy services have a $5 to $50 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED CORE 058 FL (HMO) with no copay and no coinsurance for covered options, which include annual physical exams, kidney disease education, and diabetes self-management training. While supplemental benefits like fitness programs, health education, and nutritional counseling are covered, other sub-services such as in-home support, therapeutic massage, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services covered by DEVOTED CORE 058 FL (HMO) include one routine annual hearing exam for a $5 copay and no coinsurance, with no deductible. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two aids per year, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED CORE 058 FL (HMO) vision services are partially covered, offering one routine eye exam per year with a $0 to $5 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $400 annual maximum benefit for contact lenses, eyeglasses, and upgrades.
Dental Services See details
DEVOTED CORE 058 FL (HMO) offers partially covered dental services up to a $3,500 annual maximum, with a $5 copay and no coinsurance for Medicare-covered dental, and no copay with 0% to 50% coinsurance for other covered services. While preventive care, periodontics, and oral surgery have no copay and no coinsurance, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 058 FL (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% (no coinsurance) to 20% coinsurance, while Part B insulin has a $35 copay and 0% (no coinsurance) to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by DEVOTED CORE 058 FL (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CORE 058 FL (HMO) covers medical equipment with no copays, though prior authorization is required for these services. Durable Medical Equipment (DME) features a 20% to 50% coinsurance, prosthetics and medical supplies require no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with no coinsurance to 50% coinsurance for supplies while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CORE 058 FL (HMO) with prior authorization required, featuring no coinsurance and no copay for lab services, alongside a $0 to $95 copay for diagnostic tests. Radiological services under this plan feature no copay for outpatient X-rays, no minimum copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
DEVOTED CORE 058 FL (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CORE 058 FL (HMO) with no coinsurance and require prior authorization, although some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 058 FL (HMO) 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 3-day inpatient hospital stay is not required before admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by DEVOTED CORE 058 FL (HMO), featuring additional preventive services and a $100 quarterly over-the-counter (OTC) benefit with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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