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DEVOTED CORE 005 MO (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 005 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 005 MO (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 005 MO (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Southwest/South Central Missouri. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CORE 005 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 005 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 005 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 $330.00 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 $2900.00 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 005 MO (HMO) Medicare plan features an annual prescription drug deductible of $330. Under this plan, you will have no copay for Tier 1 preferred generic and Tier 2 generic medications. This no-copay coverage applies to one-month, two-month, and three-month supplies filled at standard retail pharmacies or through standard mail order. For higher-tier medications, costs are based on a coinsurance percentage during the initial coverage phase. You will pay a 19% coinsurance for Tier 3 preferred brand drugs and a 25% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty tier drugs require a 27% coinsurance and are limited to a one-month supply at standard pharmacies or through standard mail order.
Additional Benefits
The DEVOTED CORE 005 MO (HMO) plan offers robust healthcare coverage with no copay for primary care visits, home health services, and preventive care. Specialist visits require a $30 copay, while inpatient hospital stays have a $300 daily copay for the first six days and no copay for days seven through 90. Emergency room visits carry a $150 copay, and skilled nursing care is available with no copay for the first 20 days. Additional perks include dental coverage up to $3,000 annually with no copay for preventive care, alongside a $300 yearly eyewear allowance with no copay. Hearing aids are covered with copays between $399 and $699, and members receive a $160 over-the-counter allowance every three months with no copay. Medical equipment and dialysis services are covered with no copays but require coinsurance ranging from 20% to 50%.
Inpatient Hospital See details
DEVOTED CORE 005 MO (HMO) inpatient hospital care is partially covered with no coinsurance, requiring a $300 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional days are covered for acute care, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 005 MO (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services for no copay. Outpatient hospital services require a copay between $0 and $400, observation services carry a $300 copay per stay, and individual or group outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
DEVOTED CORE 005 MO (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED CORE 005 MO (HMO) covers ambulance services with prior authorization, requiring no copay to a $315 copay and coinsurance for ground transport, and a 20% coinsurance and a copay for air transport. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by DEVOTED CORE 005 MO (HMO) with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $45 copay with no coinsurance, and worldwide emergency services are covered up to $25,000 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 005 MO (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Other covered benefits, including physical therapy, occupational therapy, and psychiatric care, feature copays ranging from $0 to $50 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED CORE 005 MO (HMO) with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and nutritional training. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, 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, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED CORE 005 MO (HMO) covers hearing services, including one annual routine exam for a $30 copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two aids per year, but 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 005 MO (HMO), featuring one annual routine eye exam with a $0 to $30 copay and no coinsurance (prior authorization required), while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $300 yearly limit for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CORE 005 MO (HMO) provides partially covered dental services up to a $3,000 annual limit, offering preventive care with no copay and no coinsurance, and restorative services with no copay and 0% to 50% coinsurance. Medicare-covered dental services require a $30 copay and no coinsurance, while orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 005 MO (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CORE 005 MO (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CORE 005 MO (HMO) covers medical equipment with no copays and prior authorization requirements, featuring 20% to 50% coinsurance for durable medical equipment, no coinsurance to 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 50% coinsurance for diabetic supplies. This benefit is partially covered because diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 005 MO (HMO) covers diagnostic and radiological services with prior authorization, offering diagnostic tests with no coinsurance and a copay ranging from no copay to $95, and lab services with no copay. Outpatient X-rays and diagnostic radiological services feature no copays, while therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CORE 005 MO (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CORE 005 MO (HMO) with no coinsurance, although prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $30 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED CORE 005 MO (HMO) with no coinsurance and no prior 3-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a daily copay of $218 for days 21 through 100, while additional days beyond the standard Medicare benefit are not covered.
Other Services See details
DEVOTED CORE 005 MO (HMO) partially covers other services, offering additional preventive services and over-the-counter (OTC) items (up to $160 every three months) with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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