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Devoted PREMIUM Ohio (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted PREMIUM Ohio (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted PREMIUM Ohio (HMO) in 2025, please refer to our full plan details page.
Devoted PREMIUM Ohio (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 4.5 out of 5 stars in 2025.
It's important to know that Devoted PREMIUM Ohio (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 PREMIUM Ohio (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 PREMIUM Ohio (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $6.00. 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 $590.00 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 $4500.00 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 PREMIUM Ohio (HMO) plan has a $590 deductible for prescription drugs. Once you meet your deductible, you will pay the following costs for drugs. For preferred generic drugs, you will pay a $5 copay at standard and mail order pharmacies. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay no cost-sharing for your Part D drugs.
Additional Benefits
The Devoted PREMIUM Ohio (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $300 copay for the first six days, and no copay for days 7-90. Outpatient services can have copays ranging from $0 to $400. The plan includes coverage for primary care with no copay, along with specialist and mental health services with a $35 copay. It also covers preventive, hearing, vision, dental, and home health services with varying costs. The plan also includes coverage for ambulance, emergency services, and home infusion services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you'll pay a $300 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you'll also pay a $300 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered, but non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and all services related to Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $400, and observation services with a $300 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $35 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted PREMIUM Ohio (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted PREMIUM Ohio (HMO) plan. Ground ambulance services have a copay between $0 and $300, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Devoted PREMIUM Ohio (HMO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a copay between $0 and $45. Worldwide Emergency Transportation has a $300 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay.
Primary Care See details
The Devoted PREMIUM Ohio (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a copay between $0 and $45, Physician Specialist Services with a $35 copay, and Mental Health Specialty Services with a $35 copay for individual and group sessions. The plan also covers Other Health Care Professional services with a copay between $0 and $35, Psychiatric Services with a $35 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $50, Additional Telehealth Benefits with a copay between $0 and $35, and Opioid Treatment Program Services with a $35 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services and annual physical exams, are covered by the Devoted PREMIUM Ohio (HMO) plan. Additional preventive services include Health Education, Personal Emergency Response System (PERS), Weight Management Programs, Alternative Therapies, Nutritional/Dietary Benefit, Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams with a $15 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $199 and $499 for 2 per year, while inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
The Devoted PREMIUM Ohio (HMO) plan covers vision services, including eye exams with a $15 copay. The plan also covers eyewear with a combined maximum of $1,000 every year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services includes coverage for oral exams with a $35 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Medicare Dental Services require prior authorization and have a $35 copay. The plan does not cover maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B insulin drugs, there is a $35 copay and 20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted PREMIUM Ohio (HMO) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 50%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered prosthetic devices and medical supplies, and Diabetic Equipment. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services includes coverage for Diagnostic Procedures/Tests with a copay between $0 and $100, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $200, Therapeutic Radiological Services with a 20% coinsurance, and Outpatient X-Ray Services with no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Devoted PREMIUM Ohio (HMO) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted PREMIUM Ohio (HMO) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for these services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted PREMIUM Ohio (HMO) plan, with no copay for days 1-20 and a $214 copay for days 21-100; additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered. Prior authorization is required for this benefit.
Other Services See details
The "Devoted PREMIUM Ohio (HMO)" plan does not cover acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. The plan covers Other 2 benefits with no copay.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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