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DEVOTED CORE 001 MO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 001 MO (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 001 MO (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 001 MO (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in St. Louis/Southeast Missouri. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CORE 001 MO (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 CORE 001 MO (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 CORE 001 MO (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 $385.00 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 $3100.00 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 CORE 001 MO (HMO) plan features an annual drug deductible of $385. Fortunately, members enjoy no copay for Tier 1 preferred generic and Tier 2 generic medications filled at standard pharmacies or through standard mail order for one, two, or three-month supplies. This provides an affordable option for individuals who primarily rely on generic prescription drugs. For brand-name and specialty medications, the plan utilizes coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for standard retail and mail-order prescriptions. Specialty drugs in Tier 5 are covered with a 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CORE 001 MO (HMO) plan offers robust core medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits, physical therapy, and mental health services, members can expect copays ranging from $25 to $50. Inpatient hospital stays require a $245 daily copay for the first eight days, after which there is no copay, while emergency room visits carry a $150 copay that is waived if admitted. This plan also includes valuable additional benefits, such as dental care with no copay for preventive services up to a $3,000 annual limit and vision coverage offering eyewear with no copay up to a $300 yearly maximum. While diagnostic lab work and outpatient X-rays require no copay, durable medical equipment and dialysis services generally carry a 20% to 50% coinsurance. Additionally, members receive a quarterly over-the-counter allowance of $160 with no copay to help cover everyday health needs.
Inpatient Hospital See details
DEVOTED CORE 001 MO (HMO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $245 daily copay for days 1 through 8 and no copay for days 9 through 90. While acute care includes unlimited additional days, psychiatric additional days, hospital upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CORE 001 MO (HMO) covers outpatient services with no coinsurance, featuring a $0 to $345 copay for outpatient hospital services and a $245 copay per stay for observation services. Ambulatory surgical center and blood services are available with no copay and no coinsurance, while individual and group outpatient substance abuse sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CORE 001 MO (HMO) with a $60.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services under DEVOTED CORE 001 MO (HMO) cover ground ambulance services with a copay ranging from no copay up to $315 and air ambulance services with a 20% coinsurance, both requiring prior authorization. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED CORE 001 MO (HMO) emergency services are covered with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay to a $45 copay with no coinsurance, and worldwide emergency services are covered up to a $25,000 lifetime maximum with a $150 copay for emergency or urgent care and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 001 MO (HMO) offers primary care physician services with no copay and no coinsurance, while telehealth benefits range from a $0 to $45 copay with no coinsurance. Specialist visits, mental health, psychiatric, and opioid treatment services require a $25 copay with no coinsurance, physical and occupational therapies carry a $25 to $50 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED CORE 001 MO (HMO) provides partial coverage for preventive services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and fitness programs. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, medical nutrition therapy, therapeutic massage, adult day health services, and home-based palliative care.
Hearing Services See details
Hearing services are partially covered by DEVOTED CORE 001 MO (HMO), which offers routine hearing exams for a $25 copay and no coinsurance. Up to two prescription hearing aids are covered per year with a copay ranging from $399 to $699 and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CORE 001 MO (HMO) with no deductible or coinsurance, offering one annual routine eye exam with a $0 to $25 copay and eyewear with no copay up to a $300 yearly limit. Other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 001 MO (HMO), offering Medicare-covered dental with a $25 copay and no coinsurance, and preventive services with no copay and no coinsurance up to a $3,000 annual maximum. Comprehensive services are available with no copay and 0% to 50% coinsurance, though orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED CORE 001 MO (HMO) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs require 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CORE 001 MO (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED CORE 001 MO (HMO) with no copays, though prior authorization is required for these benefits. Covered items include durable medical equipment with 20% to 50% coinsurance, prosthetics and medical supplies with no coinsurance to 20% coinsurance, and diabetic supplies with no coinsurance to 50% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CORE 001 MO (HMO) with prior authorization required, offering lab services with no copay and no coinsurance. Outpatient X-rays and diagnostic radiological services have no copay, diagnostic procedures and tests carry a copay of $0 to $95 with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CORE 001 MO (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CORE 001 MO (HMO) covers Cardiac Rehabilitation Services with a $25 copay, no coinsurance, and prior authorization requirements. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 001 MO (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior 3-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard 100-day benefit period are not covered.
Other Services See details
DEVOTED CORE 001 MO (HMO) partially covers other services, offering over-the-counter (OTC) items and additional preventive services with no copay and no coinsurance. OTC items feature a maximum benefit of $160 every three months, while acupuncture, meal benefits, and other additional services are not covered.
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