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DEVOTED C-SNP PREMIUM 013 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 013 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 013 MO (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP PREMIUM 013 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 013 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 013 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 013 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 $4200.00 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 013 MO (HMO C-SNP) plan features an annual drug deductible of $615. Under this plan, Select Care Drugs (Tier 6) are available with no copay for one-, two-, or three-month supplies at standard pharmacies and through standard mail order. For Tier 1 Preferred Generic drugs, standard pharmacy and mail order costs start at an $18 copay for a one-month supply, while Tier 2 Generic drugs carry a $20 copay. Higher-tier medications under this plan are subject to coinsurance rather than flat copayments. For standard pharmacy and mail order fills, Tier 3 Preferred Brand drugs require a 23% coinsurance, while Tier 4 Non-Preferred drugs require a 26% coinsurance. Specialty Tier (Tier 5) drugs are covered with a 25% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $370 for days one through six and no copay for days seven through 90. Outpatient services feature no coinsurance and variable copays ranging up to $470, while emergency care has a $150 copay that is waived upon admission. Supplemental benefits include dental care with no copay up to a $2,000 annual maximum and vision coverage that offers prescription eyewear with no copay up to $300 annually. Hearing services are also covered, featuring routine exams for a $30 copay and prescription hearing aids with copays between $399 and $699. Additionally, members receive up to $50 every three months for over-the-counter items with no copay.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $370 daily copay for days 1 to 6 and no copay for days 7 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $470 copay for outpatient hospital services, a $370 copay per stay for observation services, and a $30 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) covers partial hospitalization benefits with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services under the DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) plan require prior authorization, with ground ambulance services requiring a copay ranging from no copay to $315.00 plus coinsurance, and air ambulance services requiring a 20% coinsurance and a copay. For transportation, some services are covered, but transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours, and urgently needed services with a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 limit with a $150 copay and no coinsurance, while worldwide emergency transportation has a $315 copay and 20% coinsurance.
Primary Care See details
Primary care physician services are covered by DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) with no copay and no coinsurance, while specialist, therapy, and mental health services require copays ranging from $0 to $50 with no coinsurance. For chiropractic care, some services are covered, but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance for covered services such as annual physicals, fitness benefits, and kidney disease education. However, sub-services like in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling are not covered.
Hearing Services See details
Hearing services under DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) are partially covered, offering routine exams and fitting evaluations for a $30 copay and no coinsurance. Covered prescription hearing aids require a copay of $399 to $699 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) vision services are partially covered, featuring one routine eye exam per year with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Prescription eyewear is covered with no copay and no coinsurance, offering up to a $300 annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP), with Medicare-covered dental requiring a $30 copay and no coinsurance, and other covered dental services having no copay and no coinsurance up to a $2,000 annual maximum. Sub-services that are not covered under this plan include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs are subject to no coinsurance to 20% coinsurance, while Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) partially covers medical equipment with no copays, requiring prior authorization for these services. Durable medical equipment carries a 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance, with diabetic therapeutic shoes and inserts not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) with prior authorization required. Diagnostic tests feature no coinsurance and copays ranging from no copay to $95, while lab services have no copay and no coinsurance. Diagnostic radiological services start at no copay, outpatient X-rays require no copay but carry coinsurance, and therapeutic radiological services require a minimum 20% coinsurance plus copays.
Home Health Services See details
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay 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
DEVOTED C-SNP PREMIUM 013 MO (HMO C-SNP) offers partial coverage for other services with no copay and no coinsurance, including diabetic shoes, additional preventive services, and up to $50 every three months for over-the-counter items. Acupuncture and meal benefits are not covered.
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