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DEVOTED CORE 003 MO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 003 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 003 MO (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 003 MO (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Kansas City Metro/Northwest Missouri. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CORE 003 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 003 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 003 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 $375.00 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 $3600.00 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 003 MO (HMO) prescription drug plan features an annual drug deductible of $375. Under this plan, Tier 1 preferred generic and Tier 2 generic medications have no copay for 1-month, 2-month, or 3-month fills at standard pharmacies and standard mail order services. This provides cost-effective access to essential daily medications. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 19% coinsurance and Tier 4 non-preferred drugs require a 25% coinsurance for 1-month, 2-month, and 3-month supplies. Tier 5 specialty drugs require a 28% coinsurance for a 1-month supply through standard pharmacies or mail order.
Additional Benefits
The DEVOTED CORE 003 MO (HMO) plan offers affordable access to essential medical services, featuring no copay for primary care provider visits and a low $25 copay for specialists. Inpatient hospital stays require a $290 daily copay for the first six days and no copay for days seven through ninety, while emergency room visits carry a $150 copay that is waived if you are admitted. Outpatient procedures, diagnostic lab tests, and home health services are also highly accessible, with many of these services requiring no copay and no coinsurance. This plan also includes robust supplemental benefits to help manage your everyday health costs, including a $3,000 annual maximum for dental care with no copay for preventive services. Vision benefits feature routine exams with low copays and up to $300 annually for eyewear with no copay, while prescription hearing aids are covered with copays ranging from $399 to $699. Additionally, members receive a $100 over-the-counter allowance every three months and a fitness benefit with no copay.
Inpatient Hospital See details
DEVOTED CORE 003 MO (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $290 daily copay for days 1 through 6 and no copay for days 7 through 90. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CORE 003 MO (HMO) with no coinsurance, featuring no copay for ambulatory surgical center and blood services, and a $25 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay ranging from $0 to $390, while observation services carry a $290 copay per stay, with prior authorization required for most benefits.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CORE 003 MO (HMO) with a $60.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED CORE 003 MO (HMO) with prior authorization, requiring a copay of $0 to $315 and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 003 MO (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay ranging from no copay to $45 with no coinsurance, and worldwide emergency services are covered up to $25,000 with copays up to $315 and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 003 MO (HMO) offers partially covered primary care benefits with no coinsurance, featuring no copay for primary care provider visits and a $25 copay for specialists, mental health, and psychiatric services. Physical, occupational, and speech therapies require a $25 to $50 copay with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED CORE 003 MO (HMO) offers partial coverage for preventive services with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, fitness benefits, and nutritional counseling. However, sub-services such as in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling are not covered.
Hearing Services See details
Hearing services covered by DEVOTED CORE 003 MO (HMO) include routine exams for a $25 copay and no coinsurance, and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CORE 003 MO (HMO), which excludes other eye exam services but covers one routine eye exam yearly with a $0 to $25 copay and no coinsurance. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $300 annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CORE 003 MO (HMO) provides partially covered dental services up to a $3,000 annual maximum, featuring no copay and no coinsurance for preventive care and a $25 copay with no coinsurance for Medicare-covered dental. Other covered comprehensive services have no copay and 0% to 50% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 003 MO (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B insulin drugs have a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Medicare Part B drugs feature no copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED CORE 003 MO (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED CORE 003 MO (HMO) partially covers medical equipment with no copays, requiring 20% to 40% coinsurance for durable medical equipment and prior authorization for services. Members pay no coinsurance to 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 50% coinsurance for diabetic supplies, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 003 MO (HMO) covers diagnostic and radiological services with prior authorization required. Lab services and outpatient X-rays have no copay, while diagnostic procedures and tests carry a copay of $0 to $95 with no coinsurance. Diagnostic radiological services have a copay starting at $0, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CORE 003 MO (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CORE 003 MO (HMO) does not cover Cardiac Rehabilitation Services, as all sub-services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CORE 003 MO (HMO) with no coinsurance, requiring prior authorization but no prior three-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 Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED CORE 003 MO (HMO), offering over-the-counter (OTC) items up to $100 every three months and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered.
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