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DEVOTED CORE 001 OH (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 001 OH (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 001 OH (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 001 OH (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Northern Ohio. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 001 OH (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 001 OH (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 001 OH (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 $395.00 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 $4900.00 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 001 OH (HMO) prescription drug plan features an annual drug deductible of $395. Beneficiaries enjoy no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications for 1-month, 2-month, or 3-month supplies at standard pharmacies and standard mail order. For higher-tier prescription drugs, cost-sharing is billed as a percentage of the drug cost. Tier 3 (Preferred Brand) and Tier 4 (Non-Preferred Drug) medications require a 25% coinsurance, while Tier 5 (Specialty Tier) drugs have a 28% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED CORE 001 OH (HMO) plan offers robust coverage for essential medical needs with predictable cost-sharing. Members enjoy no copay and no coinsurance for primary care visits, preventive services, and home health care. For hospital stays, there is no coinsurance, though inpatient admissions require a $325 daily copay for the first six days, and outpatient services feature copays ranging up to $425. This plan also provides valuable supplemental benefits, including comprehensive dental coverage up to a $1,750 annual limit with no copay for preventive care. Vision and hearing benefits feature low copays for routine exams, alongside allowances for eyewear and hearing aids. Additionally, members receive a $50 quarterly allowance for over-the-counter items and pay no copay for the first 20 days of skilled nursing facility care.
Inpatient Hospital See details
DEVOTED CORE 001 OH (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 to 6 and no copay for days 7 through 90 per stay. Non-Medicare-covered stays, facility upgrades, and additional psychiatric hospital days are not covered.
Outpatient Services See details
DEVOTED CORE 001 OH (HMO) outpatient services are covered with no coinsurance, featuring a $0 to $425 copay for outpatient hospital services and a $325 copay per stay for observation services. There is no copay for ambulatory surgical center and blood services, while individual and group outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
DEVOTED CORE 001 OH (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED CORE 001 OH (HMO) with prior authorization, requiring a copay of $0 (no copay) to $315 and coinsurance for ground services, and a 20% coinsurance and a copay for air services. Transportation services are not covered.
Emergency Services See details
DEVOTED CORE 001 OH (HMO) covers emergency services with a $130 copay and no coinsurance, which is 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, while worldwide emergency services are covered up to a $25,000 lifetime maximum with copays of $130 for emergency/urgent care and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 001 OH (HMO) covers primary care physician services with no copay and no coinsurance, and telehealth benefits with a $0 to $45 copay and no coinsurance. Specialist, mental health, therapy, and psychiatric services require copays ranging from $0 to $50 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED CORE 001 OH (HMO) with no copay and no coinsurance for covered care, including annual physical exams, fitness benefits, and nutritional counseling. However, certain benefits are not covered, such as personal emergency response systems, in-home support, therapeutic massage, and medical nutrition therapy.
Hearing Services See details
DEVOTED CORE 001 OH (HMO) covers hearing services with no coinsurance, featuring a $35 copay for one annual routine hearing exam and no copay for unlimited fitting evaluations. Prescription hearing aids are partially covered with a copay ranging from $399 to $699 for up to two devices per year and no coinsurance, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED CORE 001 OH (HMO) provides partially covered vision services with no deductibles, including one annual routine eye exam with a $0 to $35 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 001 OH (HMO) up to a $1,750 annual maximum, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental requires a $35 copay and no coinsurance, while preventive services have no copay and no coinsurance. Other covered comprehensive dental services have no copay and a 0% to 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED CORE 001 OH (HMO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, require a coinsurance ranging from no coinsurance to 20%, with insulin drugs carrying a $35 copay.
Dialysis Services See details
DEVOTED CORE 001 OH (HMO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CORE 001 OH (HMO) partially covers medical equipment with no copays and prior authorization required, though diabetic therapeutic shoes and inserts are not covered. Covered items require coinsurance ranging from 20% to 50% for durable medical equipment, no coinsurance to 20% for prosthetics and medical supplies, and no coinsurance to 50% for diabetic supplies.
Diagnostic and Radiological Services See details
DEVOTED CORE 001 OH (HMO) covers diagnostic and radiological services with prior authorization required. Members pay no copay or coinsurance for lab services, outpatient x-rays, and diagnostic radiological services, while diagnostic tests and procedures carry a copay of $0 to $100 and therapeutic radiology requires 20% coinsurance.
Home Health Services See details
Home health services are covered under the DEVOTED CORE 001 OH (HMO) plan 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 CORE 001 OH (HMO) plan, as all key sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are listed as not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 001 OH (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED CORE 001 OH (HMO) partially covers Other Services, offering over-the-counter (OTC) items up to $50 every three months and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and other services under this benefit category are not covered.
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