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DEVOTED C-SNP PREMIUM 072 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 072 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 072 FL (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP PREMIUM 072 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 072 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 072 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 072 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 $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 C-SNP PREMIUM 072 FL (HMO C-SNP) Medicare prescription drug plan features an annual drug deductible of $615. For standard pharmacy and mail-order services, Tier 1 preferred generics require an $18 copay for a one-month supply, while Tier 2 generics cost a $20 copay. Crucially, Tier 6 select care drugs are highly accessible with no copay for one, two, or three-month supplies. For brand-name and specialty medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brands require 23% coinsurance, and Tier 4 non-preferred drugs carry a 26% coinsurance for standard fills. Tier 5 specialty drugs are covered at 25% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) plan offers robust medical coverage with no copay or coinsurance for primary care visits, home health services, and laboratory tests. For inpatient hospital stays, members pay a daily copay of $275 for the first five days and no copay for days six through 90. Specialist visits, routine hearing exams, and Medicare-covered dental services are also highly affordable, requiring just a $15 copay and no coinsurance. This plan also features valuable supplemental benefits, including up to $2,000 annually for covered dental services and a $300 annual allowance for eyewear with no copay. Additionally, members receive a quarterly $50 allowance for over-the-counter items with no copay. Skilled nursing facility care is covered with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) with no coinsurance and a $275 daily copay for days 1 through 5, followed by no copay for days 6 through 90. This partially covered benefit includes unlimited additional days for acute care, but does not cover upgrades, non-Medicare-covered stays, or additional days for psychiatric hospitalizations.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $275 copay for outpatient hospital and observation services. Ambulatory surgical center and blood services require no copay, while outpatient substance abuse sessions have a $15 copay.
Partial Hospitalization See details
Partial hospitalization benefits are covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) covers ambulance services with prior authorization, featuring a copay ranging from no copay to $275 for ground transport and a 20% coinsurance for air transport, while routine transportation services are not covered.
Emergency Services See details
DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with no copay to a $45 copay and no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 lifetime maximum with a $130 copay and no coinsurance, while worldwide emergency transportation carries a $275 copay and 20% coinsurance.
Primary Care See details
DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) covers primary care visits with no copay and no coinsurance, while specialist, mental health, and podiatry services require a $15 copay and no coinsurance. Physical and occupational therapy services have a $15 to $50 copay with no coinsurance, but chiropractic services are not covered.
Preventive Services See details
DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals and fitness programs. However, several sub-services are not covered, including 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, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP), offering routine hearing exams for a $15 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay of $399 to $699, but OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) partially covers vision services, as other eye exam services are not covered. Covered routine eye exams have a $0 to $15 copay and no coinsurance, while covered eyewear has no copay and no coinsurance up to a $300 annual maximum, with no deductibles for either service.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP), featuring a $15 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental services up to a $2,000 annual maximum. While many preventive and comprehensive services are covered, this plan does not cover other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) with no copay, while associated Medicare Part B chemotherapy, radiation, and other Part B drugs carry no copay and 0% to 20% coinsurance. Part B insulin drugs are also covered under this benefit with a $35 copay and 0% to 20% coinsurance, with prior authorization and step therapy required for services.
Dialysis Services See details
Dialysis services are covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required before receiving these services.
Medical Equipment See details
Medical equipment is covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) with no copays and prior authorization required, featuring a 20% to 50% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no coinsurance to 50% coinsurance for diabetic supplies, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP), requiring prior authorization. Lab services have no copay and no coinsurance, diagnostic tests have no coinsurance with a $0 to $95 copay, and outpatient X-rays have no copay. Diagnostic radiological services have copays starting at $0, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) provides Cardiac Rehabilitation Services with no coinsurance and prior authorization required, though only some services are covered. Standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for PAD services are not covered and require a $15 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no required prior 3-day hospital stay, though prior authorization is required. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with additional days beyond the standard Medicare limit not covered.
Other Services See details
Other Services are partially covered by DEVOTED C-SNP PREMIUM 072 FL (HMO C-SNP), as acupuncture and meal benefits are not covered. Covered benefits include over-the-counter (OTC) items up to $50 every three months, non-Medicare diabetic shoes, and additional preventive services, all of which feature no copay and no coinsurance.
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