DEVOTED PREMIUM 044 FL (HMO)

DEVOTED HEALTH PLAN OF FLORIDA, INC. · 2027 plan year

Plan ID H1290-044-002

HMO★ 4.5 CMS Stars
MOOP (in-network)
$4,900
MOOP (combined)
—
Monthly premium
$7.30/mo
Part C $0 + Part D $7.30, before Extra Help
Prescription drugs
Included

This plan in 2026

Plan information

Contract / Plan / Segment
H1290-044-002
Medical deductible
$0 — no deductible
Part D premium
$7.30/mo (part of the monthly premium above)Before Extra Help, which can lower or remove it for people with limited income.
Part D deductible
$650/yr
Also owed
Your Medicare Part B premium, paid separately

Other segments for this plan:

More DEVOTED HEALTH PLAN OF FLORIDA, INC. plans in FL

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Acute$150/day for days 1–6, $0 after
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$150/day for days 1–6, $0 after
Worldwide Urgent Care Coverage$130

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual Sessions$10
Mental Health — Group Sessions$10
Supplemental Health BenefitsSee plan details

Other

BenefitIn-network
Cardiac & Pulmonary RehabilitationSee plan details
Intensive Cardiac Rehabilitation — Additional Sessions$10
Vision — Eyeglass LensesNo charge
Vision — Eyeglass FramesNo charge
Vision — Eyewear UpgradesNo charge
Cardiac Rehabilitation — Additional Sessions$10
Pulmonary Rehabilitation — Additional Sessions$10
Supervised Exercise Therapy (SET)$10
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual Sessions$10
Substance Abuse — Group Sessions$10
Health EducationNo charge
Dental — Prophylaxis (Cleaning)No charge
Dental — Fluoride TreatmentNo charge
Skilled Nursing Facility (SNF)$0/day for days 1–20, $221/day for days 21–100
Emergency Services$130
Urgently Needed Services$0-$45
Worldwide Emergency & Urgent CoverageSee plan details
Worldwide Emergency Coverage$130
Worldwide Emergency Transportation$350 copay + 20% coinsurance
Partial Hospitalization Program$55
Intensive Outpatient Program (IOP)$55
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic Services$10
Occupational Therapy Services$0-$50
Physician Specialist Services$5-$15
Podiatry Services$10
Other Health Care Professional Services$0-$15
Psychiatric ServicesSee plan details
Psychiatric Services — Individual Sessions$10
Psychiatric Services — Group Sessions$10
Physical Therapy & Speech-Language Pathology$0-$50
Additional Telehealth Services (Part B)$0-$45
Opioid Treatment Program Services$10
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & Tests$0-$95
Laboratory Services$0-$20 copay + 5% coinsurance
Radiological ServicesSee plan details
Diagnostic Radiology$25-$300
Therapeutic Radiology20% coinsurance
X-Ray Services$0-$75
Outpatient Hospital Services$0-$150
Hospital Observation Services$150/day
Ambulatory Surgical Center (ASC)$0-$150
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$0-$350
Air Ambulance20% coinsurance
Durable Medical Equipment (DME)0%-50% coinsurance
Prosthetics & OrthoticsSee plan details
Prosthetic Devices0%-20% coinsurance
Medical Supplies0%-20% coinsurance
Diabetic Supplies & ServicesSee plan details
Diabetic SuppliesNo charge
Diabetic Therapeutic Shoes & InsertsNo charge
Diabetic Monitors0%-50% coinsurance
Dialysis Services20% coinsurance
Over-the-Counter (OTC) ItemsNo charge
Other Supplemental BenefitNo charge
Other Supplemental BenefitNo charge
Medicare-Covered Preventive ServicesSee plan details
Annual Physical ExamNo charge
Nutritional & Dietary BenefitNo charge
Fitness BenefitNo charge
Home & Bathroom Safety DevicesNo charge
Weight Management ProgramNo charge
Alternative TherapiesNo charge
Kidney Disease Education ServicesNo charge
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)0%-20% coinsurance (max $35)
Dental — Medicare-Covered Services$15
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — ComprehensiveSee plan details
Dental — Restorative Services50% coinsurance
Dental — Endodontics (Root Canal)50% coinsurance
Dental — Periodontics (Gum Care)50% coinsurance
Dental — Removable Prosthodontics (Dentures)50% coinsurance
Dental — Implant Services50% coinsurance
Dental — Fixed Prosthodontics (Bridges)50% coinsurance
Dental — Oral & Maxillofacial Surgery50% coinsurance
Dental — Adjunctive General Services50% coinsurance
Vision — Eye Exams$0-$10
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Hearing — Exams$10
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — Hearing Aids (All Types)$399-$699

Service area

  • FL: 3 counties

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