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DEVOTED CORE 007 OH (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 007 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 007 OH (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 007 OH (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Central Ohio. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 007 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 007 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 007 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 $375.00 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 007 OH (HMO) Medicare plan features an annual drug deductible of $375. Under this plan, you enjoy no copay for Tier 1 preferred generic medications filled through standard retail pharmacies or standard mail order. For Tier 2 generic drugs, copays are as low as $5 for a 1-month supply at standard pharmacies and standard mail order, rising slightly for 2-month and 3-month supplies. Higher-tier prescription drugs are covered under coinsurance rates rather than flat copays. Tier 3 preferred brand drugs carry a 24% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail-order fills. Tier 5 specialty drugs are covered with a 28% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED CORE 007 OH (HMO) plan offers robust coverage for essential medical needs, featuring no copays or coinsurance for primary care visits, annual physicals, and home health services. Specialist visits require a $35 copay, while inpatient hospital stays have a $350 daily copay for the first six days and no copay for days 7 through 90. Emergency room visits carry a $130 copay, which is waived if you are admitted within 24 hours, and urgent care ranges from no copay to a $45 copay. For additional wellness benefits, this plan provides preventive dental care, oral surgery, and periodontics with no copay and no coinsurance up to a $2,000 annual limit. Routine vision exams feature a $0 to $35 copay with no deductible and a $250 annual allowance for eyewear, while routine hearing exams require a $35 copay. Additionally, members receive a $30 credit every three months for over-the-counter items with no copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital care under DEVOTED CORE 007 OH (HMO) is covered with no coinsurance, featuring a $350 daily copay for days 1 to 6 and no copay for days 7 to 90. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CORE 007 OH (HMO) covers outpatient services with no coinsurance, featuring a $0 to $450 copay for outpatient hospital services and a $350 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED CORE 007 OH (HMO) with a $70.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered under DEVOTED CORE 007 OH (HMO), offering ground ambulance services with no coinsurance and a copay ranging from no copay to $315. Air ambulance services require a 20% coinsurance with no copay, while transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 007 OH (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted within 24 hours, and urgently needed services with no copay to a $45 copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 maximum limit with a $130 copay and no coinsurance, while worldwide emergency transportation has a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CORE 007 OH (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $35 copay and no coinsurance. Therapy services require a $35 to $50 copay with no coinsurance, mental health and psychiatric services require a $35 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED CORE 007 OH (HMO) provides preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay or coinsurance, excluding in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, extra smoking cessation, disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED CORE 007 OH (HMO), featuring routine hearing exams for a $35 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay between $399 and $699, though OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription models, are not covered.
Vision Services See details
Vision Services are partially covered by DEVOTED CORE 007 OH (HMO), as other eye exam services are not covered. Routine eye exams are covered with a $0 to $35 copay, no coinsurance, and no deductible, while eyewear is covered with no copay, no coinsurance, and a $250 annual maximum limit.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 007 OH (HMO), offering up to a $2,000 annual maximum with no copay and no coinsurance for preventive care, oral surgery, and periodontics. Medicare-covered dental services require a $35 copay and no coinsurance, while restorative care, endodontics, and prosthodontics feature no copay and 0% to 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CORE 007 OH (HMO) with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CORE 007 OH (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
Medical equipment is covered by DEVOTED CORE 007 OH (HMO) with no copays, though prior authorization is required. Durable medical equipment requires a 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance. Diabetic equipment is only partially covered, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 007 OH (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay and no coinsurance. Diagnostic procedures and tests have a $0 to $95 copay with no coinsurance, diagnostic radiological services have a copay starting at $0, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CORE 007 OH (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CORE 007 OH (HMO) with no copay, no coinsurance, and required prior authorization, although intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 007 OH (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED CORE 007 OH (HMO) partially covers other services, offering no copay and no coinsurance for additional preventive services and over-the-counter (OTC) items with a $30 limit every three months. Acupuncture and meal benefits are not covered.
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