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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 Clay, Duval, Nassau, and St. Johns 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 is met, you will pay a $0 copay for preferred generic drugs at standard and mail order pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance. Once your total drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Devoted EXTRA Florida (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a $175 copay for the first five days, and no copay for days 6-90, while outpatient services can have copays ranging from $0 to $175. Emergency services have a $125 copay, and primary care visits have a $10 copay. This plan also includes coverage for hearing and vision services, with a $10 copay for eye exams and hearing exams. Dental services are covered with a $10 copay for Medicare dental services, and other dental services have a $1250 annual maximum. Additionally, the plan covers home health services with no copay, and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a $175 copay for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Inpatient Hospital Psychiatric services are covered, with a $175 copay for days 1-5 and no copay for days 6-90, while Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services with a copay between $0 and $175, observation services with a $175 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a $10 copay for both individual and group sessions, and outpatient blood services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted EXTRA Florida (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted EXTRA Florida (HMO) plan. Ground Ambulance Services have a copay between $0 and $300, while Air Ambulance Services have a 20% coinsurance, and Transportation Services are not covered.
Emergency Services See details
Emergency Services for the Devoted EXTRA Florida (HMO) plan include a $125 copay, with no coinsurance. Urgently Needed Services have a copay between $0 and $45, with no coinsurance. Worldwide Emergency Services have a $125 copay for Worldwide Emergency and Urgent Coverage, and a $300 copay with 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Devoted EXTRA Florida (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $10-$45 copay, physician specialist services with a $10 copay, mental health specialty services with a $10 copay, other health care professional services with a $0-$10 copay, psychiatric services with a $10 copay, physical therapy and speech-language pathology services with a $10-$50 copay, additional telehealth benefits with a $0-$10 copay, and opioid treatment program services with a $10 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered under the Devoted EXTRA Florida (HMO) plan, including Medicare-covered preventive services, an annual physical exam, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, 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. 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 includes coverage for hearing exams with a $10 copay, and for fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $399 and $699, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $10 copay, eyewear with a combined maximum of $1250 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $10 copay, and other dental services with a $1250 annual maximum. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, prosthodontics, 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, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered by Devoted EXTRA Florida (HMO). For Medicare Part B Insulin Drugs, there is a $35 copay and a 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted EXTRA Florida (HMO) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items, 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 include coverage for all diagnostic services, diagnostic procedures/tests, and lab services with a copay of up to $95.00 for diagnostic procedures/tests and no copay for lab services. Radiological Services include coverage for diagnostic and therapeutic radiological services with a copay of up to $300 and a coinsurance of at least 20% for therapeutic radiological services, as well as no copay for outpatient X-Ray services.
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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted EXTRA Florida (HMO) plan, however, 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 are not covered. The plan has a copay for the covered 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.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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, and Self-Directed Personal Assistance Services. Other 2 benefits are covered, including $0 preventive services.
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