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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 Greater Tampa Bay. 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 $6750.00 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 for your prescriptions based on the drug tier and the pharmacy you use. In the initial coverage phase, you may pay a $0 copay for preferred generic drugs at standard and mail order pharmacies. Standard generic, preferred brand, and non-preferred drugs have a 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Devoted EXTRA Florida (HMO) plan offers comprehensive coverage with varying costs. Inpatient hospital stays have a $175 copay for the first five days, with no copay for the remainder, while outpatient services range from no copay to $175. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental, with copays ranging from $0 to $10 for many services. Additional benefits include ambulance services, emergency care, and home health services with no copay. Diagnostic and radiological services, as well as skilled nursing facility care, are also covered. However, some services like certain hearing aids, orthodontics, and specific "Other Services" are not covered by this plan.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but require prior authorization. For Inpatient Hospital-Acute, you will pay a $175 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $175 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered by the Devoted EXTRA Florida (HMO) plan, with copays ranging from $0 to $175. Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services, including individual and group sessions, are covered, with a copay of $10 per session. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted EXTRA Florida (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground ambulance services with a copay between $0 and $300, and air ambulance services with 20% coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted EXTRA Florida (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Transportation has a 20% coinsurance and a $300 copay; Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay.
Primary Care See details
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 are covered under the Devoted EXTRA Florida (HMO) plan. Chiropractic Services and Physician Specialist Services have a $10 copay, while Occupational Therapy Services have a $10-$45 copay, Physical Therapy and Speech-Language Pathology Services have a $10-$50 copay, Additional Telehealth Benefits have a $0-$10 copay, and Opioid Treatment Program Services have a $10 copay, all other services have a $10 copay.
Preventive Services See details
The Devoted EXTRA Florida (HMO) plan covers preventive services, including annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs, with no copay or coinsurance. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers, additional smoking cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $10 copay, and routine hearing exams are limited to one per year. Prescription hearing aids are covered, with a copay between $399 and $699 for all types, limited to two per year, 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, as well as eyewear coverage, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $1250 every year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $10 copay, and other dental services with a $1250 maximum benefit per year. 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 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, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted EXTRA Florida (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by the Devoted EXTRA Florida (HMO) plan, including Durable Medical Equipment (DME) with 0% to 20% coinsurance and Prosthetic Devices with 0% to 20% coinsurance, as well as Medical Supplies with 20% coinsurance; however, 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, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Devoted EXTRA Florida (HMO) plan with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted EXTRA Florida (HMO) plan, but the specific services are not covered. There is a copay for some cardiac and pulmonary rehabilitation services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted EXTRA Florida (HMO) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Devoted EXTRA Florida (HMO) plan's "Other Services" benefit does not cover 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, or Self-Directed Personal Assistance Services. Other services include preventive services with no copay.
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