A non-government entity
DEVOTED CORE 015 OH (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 015 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 015 OH (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 015 OH (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Western Ohio. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 015 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 015 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 015 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 $175.00 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:
Sign up for DEVOTED CORE 015 OH (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Devoted Core 015 OH (HMO) prescription drug plan features an annual drug deductible of $175. For Tier 1 preferred generic and Tier 2 generic medications, members pay no copay for one-month, two-month, or three-month fills at standard pharmacies and through standard mail order. This makes managing everyday generic prescriptions highly affordable under this plan. For higher-tier medications, costs are structured as coinsurance percentages at standard pharmacies and standard mail order. Tier 3 preferred brand drugs carry a 19% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CORE 015 OH (HMO) plan offers robust medical coverage with no copay for primary care visits, annual physicals, lab services, and home health care. Specialist visits, diagnostic tests, and urgent care require low copays with no coinsurance, while emergency room visits carry a $130 copay. For inpatient hospital stays, members pay a $395 daily copay for the first five days, followed by no copay for days six through ninety. Additional perks include comprehensive dental coverage up to a $3,500 annual limit with no copay for many services, and a $350 yearly allowance for eyewear. Members also benefit from a $100 over-the-counter allowance every three months and no copay for the first twenty days in a skilled nursing facility. While many services feature no coinsurance, durable medical equipment and dialysis require a 20% to 50% coinsurance.
Inpatient Hospital See details
DEVOTED CORE 015 OH (HMO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $395 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades and non-Medicare-covered stays are not covered under the plan.
Outpatient Services See details
DEVOTED CORE 015 OH (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copay and no coinsurance. Outpatient hospital services have a $0 to $495 copay, observation services have a $395 copay per stay, and substance abuse sessions have a $40 copay, all with no coinsurance.
Partial Hospitalization See details
DEVOTED CORE 015 OH (HMO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
DEVOTED CORE 015 OH (HMO) covers ambulance services with prior authorization, featuring a copay of $0 to $315 and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services, including trips to plan-approved or any health-related locations, are not covered.
Emergency Services See details
DEVOTED CORE 015 OH (HMO) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, and urgently needed services with a $0 to $45 copay and no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 maximum benefit with a $130 copay and no coinsurance, while worldwide emergency transportation has a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CORE 015 OH (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health services, and physical, occupational, or speech therapies are covered with copays ranging from $0 to $50 and no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED CORE 015 OH (HMO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, though sub-services such as in-home support, therapeutic massage, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED CORE 015 OH (HMO), which offers routine hearing exams for a $40 copay and no coinsurance, and up to two prescription hearing aids per year for a $399 to $699 copay and no coinsurance. While there is no deductible for these services, OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
DEVOTED CORE 015 OH (HMO) vision services are partially covered, as other eye exam services are not covered. Routine eye exams are covered with no copay to a $40 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $350 yearly maximum.
Dental Services See details
DEVOTED CORE 015 OH (HMO) dental services are partially covered up to a $3,500 annual maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services require a $40 copay and no coinsurance, while other covered preventive and comprehensive services feature no copay and coinsurance ranging from 0% to 50%.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CORE 015 OH (HMO) with no copay, though prior authorization is required. Medicare Part B drugs, including insulin, chemotherapy, and other drugs, are covered with coinsurance ranging from no coinsurance up to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis services are covered by the DEVOTED CORE 015 OH (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
DEVOTED CORE 015 OH (HMO) partially covers medical equipment with no copays and varying coinsurance, requiring prior authorization for all items. Durable medical equipment requires 20% to 50% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 50% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 015 OH (HMO) covers diagnostic and radiological services with prior authorization required. Members enjoy no copay for lab services and outpatient X-rays, while diagnostic procedures carry a $0 to $95 copay with no coinsurance, and therapeutic radiological services require a minimum 20% coinsurance alongside a copay.
Home Health Services See details
Home Health Services are covered under the DEVOTED CORE 015 OH (HMO) plan with no copay and no coinsurance. Prior authorization is required to access these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CORE 015 OH (HMO) with no coinsurance and prior authorization required, though some services are covered while others are not. Specifically, cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($35 copay), and SET for PAD services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 015 OH (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED CORE 015 OH (HMO), which provides over-the-counter (OTC) items up to $100 every three months and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and dual-eligible SNP services are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved