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DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in South & Central Florida. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP).
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 C-SNP PREMIUM 069 FL (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $615.00 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 $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 C-SNP PREMIUM 069 FL (HMO C-SNP) plan features an annual prescription drug deductible of $615. Under this plan, Tier 6 select care drugs are available with no copay for up to a three-month supply through standard retail pharmacies and standard mail order. For Tier 1 preferred generic drugs, you will pay an $18 copay for a one-month supply, while Tier 2 generic drugs require a $20 copay. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 23% coinsurance, and Tier 4 non-preferred drugs carry a 26% coinsurance for standard pharmacy and mail-order fills. Additionally, Tier 5 specialty drugs are available with a 25% coinsurance for a one-month supply through standard services.
Additional Benefits
The DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) plan offers comprehensive medical coverage with no copays for primary care visits, home health services, and preventive care. Specialists require a low $10 copay, while inpatient hospital stays cost a $175 daily copay for the first five days and no copay for days six through 90. Emergency room visits carry a $150 copay, which is waived if you are admitted, and urgent care costs range from no copay to $45. For ancillary care, members enjoy dental coverage up to a $2,000 annual limit with no copay for preventive and comprehensive services. Vision benefits feature routine exams for up to a $10 copay and an annual $300 eyewear allowance, while hearing aids are available with a copay between $399 and $699. Additionally, medical equipment and diagnostic lab services require no copay, though dialysis and some Part B drugs carry a 20% coinsurance.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) inpatient hospital services are partially covered with no coinsurance, requiring a daily copay of $175 for days 1 through 5 and no copay for days 6 through 90. While unlimited additional acute stay days are covered, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and blood services. Outpatient hospital services require no copay to a $175 copay (including a $175 copay per stay for observation services), while outpatient substance abuse sessions require a $10 copay and no coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) covers ambulance services with prior authorization, featuring a copay ranging from no copay to $255 and coinsurance for ground transport, and a 20% coinsurance and a copay for air transport. While some transportation services are covered, transportation to plan-approved or any other health-related locations is not covered.
Emergency Services See details
Emergency services under DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) are covered with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $45 copay with no coinsurance, and worldwide emergency benefits are covered up to $25,000 with a $150 copay for care and a $255 copay plus 20% coinsurance for transportation.
Primary Care See details
Primary care benefits under DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) feature no copay and no coinsurance for primary care physician visits, and a $10 copay with no coinsurance for specialists. Physical, occupational, and speech therapies require a $10 to $50 copay with no coinsurance, and while some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and fitness benefits. However, sub-services such as in-home safety assessments, personal emergency response systems (PERS), post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing services are covered by DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP), featuring a $10 copay and no coinsurance for annual routine hearing exams and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $399 to $699 for up to two devices yearly, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) because other eye exam services are not covered. Routine eye exams are covered once yearly with a $0 to $10 copay, no coinsurance, and no deductible, while eyewear is covered with no copay, no coinsurance, and a $300 annual maximum benefit.
Dental Services See details
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) features partially covered dental services with an annual maximum of $2,000, requiring a $10 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered preventive and comprehensive services. Sub-services not covered by the plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs, such as chemotherapy and insulin, carry a coinsurance ranging from 0% to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) with no copays for all covered items, though coinsurance ranges from no coinsurance to 30% depending on the service. While durable medical equipment, prosthetics, and diabetic supplies are covered, diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) covers diagnostic and radiological services, with prior authorization required for both. Diagnostic services feature no coinsurance, offering no copay for lab services and a $0 to $95 copay for diagnostic procedures, while radiological services include no copay for outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to access these fully covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) plan, meaning there is no coverage for cardiac, intensive cardiac, pulmonary, or supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP) with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP PREMIUM 069 FL (HMO C-SNP), featuring over-the-counter items (up to $50 every three months), non-Medicare covered diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered.
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