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Devoted EXTRA Arizona (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted EXTRA Arizona (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted EXTRA Arizona (HMO) in 2025, please refer to our full plan details page.
Devoted EXTRA Arizona (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Maricopa and Pinal Counties. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Devoted EXTRA Arizona (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 Arizona (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 Arizona (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 $5900.00 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 Arizona (HMO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. In the initial coverage phase, after you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy. For example, you may pay a $5.00 copay for preferred generic drugs at a standard or mail-order pharmacy. Once your total drug costs reach $2,000.00, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Devoted EXTRA Arizona (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and partial hospitalization. You'll have access to emergency services, primary care, and preventive services with no copays for many services, and copays for others. The plan also covers hearing, vision, and dental services, along with medical equipment and home health services. This plan also covers ambulance and transportation services with varying copays and coinsurance. Diagnostic and radiological services, skilled nursing facility stays, and home infusion services are also available, though some require prior authorization. However, certain services like cardiac rehabilitation, acupuncture, and over-the-counter items are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Devoted EXTRA Arizona (HMO) plan. For Inpatient Hospital-Acute, you'll pay a $335 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you'll pay a $335 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $435, observation services with a $335 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services. Outpatient substance abuse services have a $40 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted EXTRA Arizona (HMO) plan, with a $70 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted EXTRA Arizona (HMO) plan. Ground ambulance services have a copay between $0 and $350, while air ambulance services have a 20% coinsurance, and other transportation services are not covered.
Emergency Services See details
Emergency Services are covered under the Devoted EXTRA Arizona (HMO) plan, with a $125 copay. Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Services are also covered, with a $125 copay for Worldwide Emergency and Urgent Coverage, and a $350 copay with 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Devoted EXTRA Arizona (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professionals, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, physician specialist services have a $40 copay, occupational therapy services have a copay between $40 and $45, and physical therapy and speech-language pathology services have a copay between $40 and $65, while additional telehealth benefits have a copay between $0 and $40. Individual and group sessions for mental health and psychiatric services, as well as opioid treatment program services, have a $40 copay. Other health care professionals have a copay between $0 and $40. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Devoted EXTRA Arizona (HMO) plan covers preventive services including Medicare-covered services with no copay, annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs with no copay. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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, additional sessions of smoking cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $40 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $699. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services with the Devoted EXTRA Arizona (HMO) plan includes eye exams with a $40 copay, routine eye exams once per year, and eyewear with a combined maximum of $1000 per year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Devoted EXTRA Arizona (HMO) plan covers dental services, including 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, with a $1,000 annual maximum. Medicare dental services have a $40 copay, and orthodontic services are covered under diagnostic and preventive dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Devoted EXTRA Arizona (HMO) plan, but require prior authorization. Insulin has a $35 copay and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Devoted EXTRA Arizona (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a coinsurance between 0% and 20%, and Medical Supplies with a 20% coinsurance, while Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
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 $275, 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 Arizona (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted EXTRA Arizona (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted EXTRA Arizona (HMO) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-60 there is a $200 copay, and for days 61-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services, for the Devoted EXTRA Arizona (HMO) plan, does not cover acupuncture, over-the-counter (OTC) items, or meal benefits. Other services are covered, but does not cover the following: 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.
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