We have 2 plans in Palm Beach County.

Monthly Premium

$30.30
If you get Extra Help from Medicare, it may lower your Devoted premium.

$0

Pharmacy (Part D) Deductible

$415
You have to pay this amount out of your own pocket before your plan starts to cover your drugs.

$0

30-Day Supply Retail Pharmacy

If you get Extra Help from Medicare, your costs may be lower.

• Tier 1: $0 copay*
• Tier 2: $0 copay*
• Tier 3: 25% of drug cost*
• Tier 4: 25% of drug cost*
• Tier 5: 25% of drug cost*

• Tier 1: $0 copay*
• Tier 2: $0 copay*
• Tier 3: $47 copay*
• Tier 4: $95 copay*
• Tier 5: 33% of drug cost*

90-Day Supply Mail-order Pharmacy

If you get Extra Help from Medicare, your costs may be lower.

• Tier 1: $0 copay*
• Tier 2: $0 copay*
• Tier 3: 25% of drug cost*
• Tier 4: 25% of drug cost*
• Tier 5 drugs are not available through mail order

• Tier 1: $0 copay*
• Tier 2: $0 copay*
• Tier 3: $117.50 copay*
• Tier 4: $237.50 copay*
• Tier 5 drugs are not available through mail order

Annual Out-of-Pocket Maximum

This is the most you'd pay in a year for covered medical services. Once you reach it, your plan pays all the costs.

$3,400 (in network)

$3,400 (in network)

Primary Care Provider (PCP) Visits

$0 copay*

$0 copay*

Specialist Visits

$0 copay*

$15 copay*

Inpatient Hospital Stays

$0 copay*
For surgery and other medical reasons

• Days 1 to 9: $150 a day copay*
• Starting on Day 10: $0 copay*

For surgery and other medical reasons

Urgent Care

$0 copay at urgent care centers

$0 copay at urgent care centers

Emergency Room Visit

$75 copay
If you get admitted (checked-in) to the hospital, you won't have to pay this.

$90 copay
If you get admitted (checked-in) to the hospital, you won't have to pay this.

Outpatient Surgery

$0 copay*

• $100 copay at stand-alone surgery centers*
• $150 copay at outpatient hospitals*

Labs

$0 copay*

• $0 copay at a PCP's office, specialist's office, or urgent care center*
• $25 copay at outpatient hospitals*

X-rays

$0 copay*

• $0 copay at a PCP's office, specialist's office, or urgent care center*
• $50 copay at outpatient hospitals*

Diagnostic Tests and Procedures

$0 copay*

• $0 copay at a PCP's office, specialist's office, or urgent care center*
• $50 copay at outpatient hospitals*

Dental Services

Yes*
You're covered for things like routine exams, cleanings, fillings, and dentures.

Yes*
You're covered for things like routine exams, cleanings, fillings, and dentures.

Eyewear Benefit

$200 a year*
Toward glasses or contact lenses

$200 a year*
Toward glasses or contact lenses

Hearing Aid Benefit

$600 a year (per ear)*
Toward hearing aids

$600 a year (per ear)*
Toward hearing aids

Over-the-counter Health and Wellness Benefit

$85 a month*
Toward things like pain relievers, vitamins, and first-aid supplies

$50 a month*
Toward things like pain relievers, vitamins, and first-aid supplies

Rides to and from Your Doctor

Yes*

Yes*

Fitness Benefit

Called SilverSneakers, this benefit gives you free access to lots of gyms and fitness centers.

Yes*

Yes*

Acupuncture

Yes*

Yes*