4

4 out of 5 stars* for plan year 2024

Plan ID: H1290-009

What You Need to Know:

  • Devoted Health Prime Greater Tampa Bay (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $31, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $445 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $3,400 per year (in-network).
  • Devoted Health Prime Greater Tampa Bay (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $445 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $31.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$31

Monthly Premium

Medicare Plan Features
Monthly Premium: $30.80
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$30.80 $0 $30.80 $0 $30.80 $445.0 1.0
Gap Coverage: No
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H1290-010
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: No additional gap coverage, only the Donut Hole Discount
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $3,400
Annual Deductible: $445 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Hernando, Florida: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
24 members New plan - No summary rating as of yet. 4 out of 5 Stars. 5 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,219 drugs
Number of Members Enrolled in this Plan in Hernando, Florida: NULL
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $30.80 $0.00 $30.80
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$0.00 $23.10 $23.10 $15.40 $15.40 $7.70 $7.70
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
241 $0.00 495 $0.00 1058 25% 774 25% 651 25%

Other Medicare Advantage Plans in Hernando, Florida

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AARP Medicare Advantage Choice Plan 2 (Regional PPO) (2023)Regional PPO$6,700$395
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HumanaChoice Florida H5216-072 (PPO) (2023)Local PPO$4,900$150
4
Humana Gold Plus H1036-265 (HMO) (2023)Local HMO$2,750$0
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Cigna Primary Medicare (HMO) (2023)Local HMO$3,500$445
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AARP Medicare Advantage Choice (PPO) (2023)Local PPO$5,500$150
5
Freedom Savings Plan (HMO) (2023)Local HMO *$3,400$-
4
Cigna Preferred Medicare (HMO) (2023)Local HMO$3,650$0
5
Humana Gold Choice H8145-061 (PFFS) (2023)PFFS$-$200
4
Cigna Preferred Savings Medicare (HMO) (2023)Local HMO$3,950$0
5
Aetna Medicare Eagle (PPO) (2023)Local PPO *$5,500$-
5
Humana Honor (HMO) (2023)Local HMO *$4,500$-
4
HumanaChoice R5826-074 (Regional PPO) (2023)Regional PPO$7,550$395
4
AARP Medicare Advantage (HMO-POS) (2023)Local HMO$4,900$0
5
BlueMedicare Value (PPO) (2023)Local PPO$4,500$150
4
Simply More (HMO) (2023)Local HMO$3,450$0
5
WellCare Dividend Prime (HMO) (2023)Local HMO$2,500$0
4
WellCare Elite (HMO) (2023)Local HMO$1,200$0
4
AARP Medicare Advantage Patriot (Regional PPO) (2023)Regional PPO *$6,700$-
5
HumanaChoice R5826-005 (Regional PPO) (2023)Regional PPO$6,700$100
4
Aetna Medicare Premier (PPO) (2023)Local PPO$6,700$300
5
Simply Select (HMO) (2023)Local HMO$3,450$445
5
Aetna Medicare Premier Plus (PPO) (2023)Local PPO$5,500$150
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
WellCare Premier (PPO) (2023)Local PPO$3,400$100
New plan - not yet rated.
Devoted Health Core Greater Tampa Bay (HMO) (2023)Local HMO$2,900$0
4
Devoted Health Essentials Greater Tampa Bay (HMO) (2023)Local HMO$3,400$0
4
HumanaChoice R5826-018 (Regional PPO) (2023)Regional PPO *$7,550$-
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
BlueMedicare Classic (HMO) (2023)Local HMO$4,900$0
4
Medicare Advantage Plans by Devoted Health
Devoted Health Core Greater Tampa Bay (HMO) (2023)Local HMO$2,900$0
4
Devoted Health Essentials Greater Tampa Bay (HMO) (2023)Local HMO$3,400$0
4

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