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DEVOTED DUAL 011 OH (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL 011 OH (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED DUAL 011 OH (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL 011 OH (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Ohio. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED DUAL 011 OH (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED DUAL 011 OH (HMO D-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 DUAL 011 OH (HMO D-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 DUAL 011 OH (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.40. 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 $4300.00 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 DUAL 011 OH (HMO D-SNP) Medicare plan features an annual drug deductible of $615. For prescription drug coverage during the initial coverage phase, standard retail pharmacies and standard mail-order services charge a 25% coinsurance for Tiers 1 through 4. This 25% coinsurance applies to preferred generic, generic, preferred brand, and non-preferred drugs across one-month, two-month, and three-month supplies. For Tier 5 specialty drugs, standard pharmacy and mail-order fills carry a 25% coinsurance for a one-month supply. Additionally, Tier 6 select care drugs are fully covered with no copay for one-month, two-month, and three-month supplies at standard pharmacies and standard mail-order outlets.
Additional Benefits
The DEVOTED DUAL 011 OH (HMO D-SNP) plan offers comprehensive medical coverage, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $300 daily copay for the first six days and no copay for days 7 through 90, with no coinsurance required. Emergency room visits carry a $130 copay, while outpatient hospital services range from no copay up to a $400 copay. This plan also provides robust supplemental benefits, including no copay and no coinsurance for routine vision care with a $400 annual allowance, and comprehensive dental services up to a $2,000 yearly limit. Hearing aids are covered with copays ranging from no copay to $299, and members receive a $50 over-the-counter allowance every three months with no copay. Specialist visits, diagnostic labs, and medical equipment are also covered, though some services like durable medical equipment require a 20% to 30% coinsurance.
Inpatient Hospital See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $300 per day for days 1 through 6, followed by no copay for days 7 through 90. While unlimited additional days are covered for acute stays, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers outpatient services with no coinsurance, though prior authorization is required. Outpatient hospital copays range from $0 to $400, observation services carry a $300 copay, and substance abuse sessions require a $35 copay, while ambulatory surgical center and blood services are covered with no copay.
Partial Hospitalization See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers ambulance services with prior authorization, offering ground transport with no copay to a $315 copay and no coinsurance, and air transport with a 20% coinsurance and no copay. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted within 24 hours, and urgently needed services with a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency services are covered up to $25,000, featuring a $130 copay and no coinsurance for emergency or urgent care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require copays ranging from $35 to $50 and no coinsurance. Chiropractic services are not covered in practice, but telehealth benefits and up to six routine podiatry visits per year are covered with no coinsurance and copays up to $45.
Preventive Services See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, but exclude services like in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, therapeutic massage, and caregiver support.
Hearing Services See details
DEVOTED DUAL 011 OH (HMO D-SNP) hearing services are partially covered, featuring a $35 copay and no coinsurance for annual routine hearing exams, which require prior authorization. Prescription hearing aids are covered up to two per year with no coinsurance and copays ranging from no copay to $299, but over-the-counter (OTC) hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by DEVOTED DUAL 011 OH (HMO D-SNP) with no copay and no coinsurance, offering one routine eye exam per year and a $400 annual allowance for contacts, eyeglasses, and upgrades. This benefit is partially covered because other eye exam services are not covered, and prior authorization is required for exams.
Dental Services See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers Medicare-covered dental services with a $35 copay and no coinsurance, while other preventive and comprehensive dental services are covered with no copay and no coinsurance up to a $2,000 annual maximum. Covered comprehensive options include restorative care, endodontics, periodontics, prosthodontics, and orthodontics, many of which require prior authorization.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED DUAL 011 OH (HMO D-SNP) with no copay, though prior authorization and step therapy apply. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and between no coinsurance and 20% coinsurance, while Part B insulin has a $35 copay and between no coinsurance and 20% coinsurance.
Dialysis Services See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers medical equipment with no copays and prior authorization required, featuring a 20% to 30% coinsurance for durable medical equipment. Prosthetics and medical supplies are covered with no coinsurance to 20% coinsurance, while diabetic equipment is partially covered, offering diabetic supplies with no coinsurance to 30% coinsurance but excluding diabetic therapeutic shoes and inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED DUAL 011 OH (HMO D-SNP) with prior authorization required. Diagnostic procedures and tests have no coinsurance and a copay of $0 to $100, while lab services feature no copay and no coinsurance. Outpatient X-rays have no copay but require coinsurance, diagnostic radiological services have a $0 minimum copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
DEVOTED DUAL 011 OH (HMO D-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED DUAL 011 OH (HMO D-SNP) with no copay and no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by DEVOTED DUAL 011 OH (HMO D-SNP) with no coinsurance, requiring prior authorization and 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, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED DUAL 011 OH (HMO D-SNP) partially covers other services with no copay and no coinsurance for additional preventive services and over-the-counter (OTC) items, which includes a $50 allowance every three months. Acupuncture, meal benefits, and highly integrated dual eligible services are not covered under this benefit.
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