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DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Southern Missouri. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP).
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 C-SNP PREMIUM 012 MO (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.00. 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 $615.00 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 $3000.00 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 C-SNP PREMIUM 012 MO (HMO C-SNP) prescription drug plan features an annual drug deductible of $615. For standard pharmacy and mail-order prescriptions, Tier 6 Select Care Drugs are covered with no copay for up to a three-month supply. Tier 1 Preferred Generic drugs carry an $18 copay for a one-month supply, while Tier 2 Generic drugs cost a $20 copay for a one-month supply. For brand-name and specialty medications, costs are based on coinsurance rather than set copays. Tier 3 Preferred Brand drugs require a 23% coinsurance, Tier 4 Non-Preferred Drugs require a 26% coinsurance, and Tier 5 Specialty Tier drugs require a 25% coinsurance for a one-month supply. Understanding these tier-based costs can help you estimate your out-of-pocket prescription expenses with the DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) plan.
Additional Benefits
The DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) plan offers robust medical coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $325 daily copay for days 1 through 6 and no copay for days 7 through 90, with no coinsurance. Emergency room visits feature a $150 copay that is waived if admitted, while specialist visits require a copay of $35 to $50. Ancillary benefits under the DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) include dental care with no copay up to a $2,000 annual limit and vision coverage with no copay for eyewear up to a $300 annual allowance. Prescription hearing aids require a copay of $399 to $699, whereas diagnostic lab and X-ray services are covered with no copay. For durable medical equipment and dialysis services, members pay no copay and a 20% to 50% coinsurance.
Inpatient Hospital See details
Inpatient hospital services under DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) are partially covered with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and while unlimited additional days are covered for acute stays, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a $0 to $425 copay, observation services have a $325 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) plan with a $60.00 copay and no coinsurance. Prior authorization is required to access these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP), with ground ambulance services requiring a $0 to $315 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Although some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services under the DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) plan are covered with a $150 copay and no coinsurance, with the copay waived if admitted to the hospital within 24 hours. Urgently needed services feature no copay to a $45 copay and no coinsurance, while 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 C-SNP PREMIUM 012 MO (HMO C-SNP) offers primary care physician visits with no copay and no coinsurance, while specialist, mental health, and therapy services require copays ranging from $35 to $50 and no coinsurance. Some chiropractic services are covered, but routine chiropractic care and other chiropractic services are not covered. Telehealth benefits are also available with a $0 to $45 copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) with no copay and no coinsurance for covered options like annual physicals, fitness benefits, and nutritional therapy. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems (PERS), post-discharge medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
Hearing services are covered by DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) with a $35 copay and no coinsurance for exams, and a $399 to $699 copay and no coinsurance for prescription hearing aids. This benefit is partially covered because OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP), excluding other eye exam services but covering one routine eye exam per year with a $0 to $35 copay and no coinsurance. Eyewear is covered with no copay and no coinsurance, providing a $300 annual maximum allowance for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP), offering key preventive and comprehensive care with no copay and no coinsurance up to a $2,000 annual limit, though Medicare-covered dental requires a $35 copay and no coinsurance. While cleanings, fillings, and dentures are covered, this plan does not cover other diagnostic or preventive dental services, maxillofacial prosthetics, implants, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) with no copay, subject to prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) covers medical equipment with no copays, featuring coinsurance of 20% to 50% for durable medical equipment, no coinsurance to 20% for prosthetics and medical supplies, and no coinsurance to 50% for diabetic supplies. This benefit is partially covered, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) with prior authorization required. Diagnostic tests and procedures have no coinsurance and a copay ranging from $0 to $95, while lab, diagnostic radiology, and outpatient X-ray services feature no copay. Therapeutic radiological services are subject to a 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) plan, meaning there is no copay or coinsurance because cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no prior three-day hospital stay, though prior authorization is needed. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard 100-day limit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 012 MO (HMO C-SNP) offers partially covered other services, excluding acupuncture and meal benefits. Covered benefits, including over-the-counter items (up to $50 every three months), non-Medicare diabetic shoes, and additional preventive services, are available with no copay and no coinsurance.
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