2019 Devoted Health Broward (HMO) H1290-2-0 in FL from Devoted Health | HealthPocket

Devoted Health Broward (HMO)

$0/mo

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Zip Code33186
Applicant8/26/1984 Male
Coverage Start8/27/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderDevoted Health
Plan IDH1290-2-0
Plan Year2019
CMS RatingNot Rated
Plan TypeHMO
Annual Deductible$0.00

What To Know About This Plan
  • This plan has health and drug coverage

Why We Like This Plan
  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$3,400 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverage$0 copay
Outpatient hospital coverage$100 per visit
Doctor visitsPrimary:$0 copay
Specialist:$5 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$0 copay
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$0-25
Lab services:$0-25
Diagnostic radiology services (e.g., MRI):$0-125
Outpatient x-rays:$0-25
Mental health servicesInpatient hospital - psychiatric:$0 copay
Outpatient group therapy visit with a psychiatrist:$5
Outpatient individual therapy visit with a psychiatrist:$5
Outpatient group therapy visit:$5
Outpatient individual therapy visit:$5
Skilled Nursing Facility$0 per day for days 1 through 20
$150 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:$5-25
Physical therapy and speech and language therapy visit:$5-25
Ground ambulance$200
Transportation$0 copay. There may be limits on how much the plan will provide.
Foot care (podiatry services)Foot exams and treatment:$5
Routine foot care:$5There may be limits on how much the plan will provide.
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:$0 copay
Wellness programs (e.g., fitness, nursing hotline)Covered
Medicare Part B drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam$5
Fitting/evaluation$0 copay. There may be limits on how much the plan will provide.
Hearing aids$0 copay. There may be limits on how much the plan will provide.
Preventive Dental
Oral exam$0 copay. There may be limits on how much the plan will provide.
Cleaning$0 copay. There may be limits on how much the plan will provide.
Fluoride treatmentNot covered
Dental x-ray(s)$0 copay. There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesNot covered
Diagnostic servicesNot covered
Restorative services$0 copay. There may be limits on how much the plan will provide.
EndodonticsNot covered
Periodontics$0 copay. There may be limits on how much the plan will provide.
Extractions$0 copay. There may be limits on how much the plan will provide.
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay. There may be limits on how much the plan will provide.
Vision
Routine eye exam$0 copay. There may be limits on how much the plan will provide.
OtherNot covered
Contact lenses$0 copay. There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)$0 copay. There may be limits on how much the plan will provide.
Eyeglass frames$0 copay. There may be limits on how much the plan will provide.
Eyeglass lenses$0 copay. There may be limits on how much the plan will provide.
UpgradesNot covered

Coverage Area for Devoted Health Broward (HMO)

StateFlorida
CountyMiami-Dade

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$0 copayNot offered
Tier 3: Preferred Brand NameNot offered$20 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$85 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered

90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$0 copayNot offered
Tier 2: Non-Preferred GenericNot offered$0 copayNot offered
Tier 3: Preferred Brand NameNot offered$60 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$255 copayNot offered
Tier 5: Specialty Tier

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)