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DEVOTED C-SNP PLUS 089 FL (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PLUS 089 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 PLUS 089 FL (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PLUS 089 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 PLUS 089 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 PLUS 089 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 PLUS 089 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 PLUS 089 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 $9250.00 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 PLUS 089 FL (HMO C-SNP) prescription drug plan features an annual drug deductible of $615. Under this plan, Tier 1 preferred generic drugs require an $18 copay for a 1-month supply at standard pharmacies and standard mail-order services. Tier 2 generic drugs carry a $19 copay for a 1-month supply under the same standard pharmacy and mail-order options. For higher-tier medications, Tier 3 preferred brand drugs and Tier 5 specialty drugs both incur a 25% coinsurance, while Tier 4 non-preferred drugs require a 31% coinsurance. Tier 6 select care drugs are fully covered with no copay for 1-month, 2-month, or 3-month supplies through standard pharmacies and mail order. This plan offers clear cost-sharing tiers to help beneficiaries manage their prescription drug expenses.
Additional Benefits
The DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For specialized care, members pay no copay but will face a 30% coinsurance for specialist visits and up to a 50% coinsurance for outpatient and diagnostic services. Inpatient hospital stays require a copay of $2,230 per admission, while emergency room visits carry a $115 copay that is waived if you are admitted. This plan also features valuable supplemental benefits, including no copay for routine vision and dental services up to generous annual limits, alongside a $300 eyewear allowance. Members pay no copay for durable medical equipment but are responsible for a 20% coinsurance, and prescription hearing aids require a copay between $399 and $699. Additionally, the plan provides an over-the-counter item allowance of $50 every three months with no copay or coinsurance.
Inpatient Hospital See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) covers inpatient acute hospital stays with a $2,230 copay per admission and unlimited additional days, and inpatient psychiatric care with a $2,080 copay per admission, both with no coinsurance. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) covers outpatient services with no copays, though coinsurance applies depending on the specific service. Outpatient hospital and ambulatory surgical center services range from no coinsurance up to 50% coinsurance, while outpatient substance abuse and blood services require 30% coinsurance with no deductible.
Partial Hospitalization See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) covers ambulance services with prior authorization, requiring no copay and a coinsurance of 50% for air ambulance and no coinsurance to 50% coinsurance for ground ambulance. This coinsurance is not waived upon hospital admission, and transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and a 0% to 20% coinsurance (up to $40 per visit), while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $25,000 maximum limit.
Primary Care See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, alongside telehealth benefits featuring no copay and 0% to 30% coinsurance. Specialist visits, physical and occupational therapy, mental health, and psychiatric services are covered with no copay and 30% coinsurance, though chiropractic services are not covered.
Preventive Services See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes training. Additional preventive benefits are partially covered with no copay or coinsurance for services like fitness and nutrition programs, while others such as personal emergency response systems (PERS) and in-home support are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP PLUS 089 FL (HMO C-SNP), featuring annual routine hearing exams with no copay and 50% coinsurance, and up to two prescription hearing aids per year with a $399 to $699 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP PLUS 089 FL (HMO C-SNP), offering one annual routine eye exam with no copay and 0% to 50% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $300 annual maximum allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) offers partially covered dental services with no copay and 30% coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $3,500 annual maximum. Dental services that are not covered under this plan include other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) covers medical equipment with no copays, featuring a 20% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with a 20% coinsurance for supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) with prior authorization required and no copays for any services. There is no coinsurance for diagnostic procedures and tests, but a 20% coinsurance applies to therapeutic radiological services, and a 50% coinsurance applies to lab services, diagnostic radiological services, and outpatient X-rays.
Home Health Services See details
Home health services are covered under the DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) plan with no copay, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
DEVOTED C-SNP PLUS 089 FL (HMO C-SNP) partially covers other services, providing 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 under this plan.
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