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DEVOTED C-SNP PREMIUM 014 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 014 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 014 MO (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP PREMIUM 014 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 014 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 014 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 014 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 014 MO (HMO C-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 6 select care drugs, you will pay no copay for one-, two-, or three-month supplies at standard pharmacies and through standard mail order. Tier 1 preferred generics carry an $18 copay for a one-month supply, while Tier 2 generic drugs require a $20 copay. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands have a 23% coinsurance, Tier 4 non-preferred drugs have a 26% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply. These standard pharmacy and mail-order rates help you easily calculate your out-of-pocket prescription costs.
Additional Benefits
The DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) plan offers robust healthcare coverage with no copay and no coinsurance for primary care visits, preventive care, and home health services. For hospital stays, members pay a daily copay of $380 for the first six days of inpatient care with no coinsurance, followed by no copay for days 7 through 90. Outpatient hospital services feature a copay ranging from no copay up to $480, while emergency room visits carry a $150 copay that is waived if you are admitted to the hospital within 24 hours. Specialist consultations, mental health therapy, and Medicare-covered dental services require a $35 copay and no coinsurance, but preventive and comprehensive dental care are covered with no copay up to a $2,000 annual limit. Vision benefits include a routine annual exam with no copay to a $35 copay and a $300 eyewear allowance, while hearing exams require a $35 copay. Additionally, diagnostic lab tests and outpatient X-rays are provided with no copay, and skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) partially covers inpatient hospital services, with upgrades and non-Medicare-covered stays excluded from coverage. For both acute and psychiatric stays, there is no coinsurance, but a copay of $380 per day applies for days 1 through 6, followed by no copay for days 7 through 90. Prior authorization is required, and unlimited additional days are covered only for acute care.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) with no coinsurance, featuring a $0 to $480 copay for outpatient hospital services and a $380 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while outpatient substance abuse sessions carry a $35 copay and no coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) covers partial hospitalization with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) plan, with ground ambulance requiring prior authorization and carrying no copay to a $315 copay plus coinsurance, and air ambulance requiring prior authorization with a 20% coinsurance plus a copay. While transportation is covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) 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 feature no coinsurance and a copay ranging from no copay to $45, while worldwide emergency services are covered up to a $25,000 limit with a $150 copay and no coinsurance for emergency and urgent care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialist, mental health, psychiatric, podiatry, and opioid treatment services require a $35 copay and no coinsurance. Physical, occupational, and speech therapy services have a $35 to $50 copay and no coinsurance, telehealth ranges from a $0 to $45 copay and no coinsurance, and chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) with no copay and no coinsurance for covered services like annual physical exams and kidney disease education. Sub-services that are not covered under this plan include In-Home Safety Assessments, Personal Emergency Response Systems (PERS), post-discharge medication reconciliation, re-admission prevention, chemotherapy 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
Hearing services are partially covered by DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP), featuring a $35 copay and no coinsurance for exams, and a $399 to $699 copay with no coinsurance for prescription hearing aids. OTC hearing aids, alongside inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) partially covers vision services, as other eye exam services are not covered. Covered benefits include one routine eye exam per year with a $0 to $35 copay, and eyewear with no copay up to a $300 annual limit, both with no deductibles and no coinsurance.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive and comprehensive care up to a $2,000 annual limit. While many treatments are covered, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs incur 0% to 20% coinsurance with no copay, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment has a 20% to 50% coinsurance, while prosthetics and medical supplies range from no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with no coinsurance to 50% coinsurance, but 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 014 MO (HMO C-SNP) with prior authorization required. Members pay no copay for lab services and outpatient X-rays, a $0 to $95 copay with no coinsurance for diagnostic procedures, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) require prior authorization and have no coinsurance. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, and pulmonary rehabilitation services (each requiring a $35 copay), as well as supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services (requiring a $30 copay), are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP) with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP PREMIUM 014 MO (HMO C-SNP), featuring no copay and no coinsurance for over-the-counter items up to $50 every three months, diabetic shoes, and additional preventive services. Acupuncture and meal benefits are not covered under this plan.
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