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DEVOTED C-SNP PLUS 016 OH (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PLUS 016 OH (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP PLUS 016 OH (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP PLUS 016 OH (HMO C-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 C-SNP PLUS 016 OH (HMO C-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 C-SNP PLUS 016 OH (HMO C-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 $9250.00 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 C-SNP PLUS 016 OH (HMO C-SNP) Medicare plan features an annual drug deductible of $615. For lower-tier medications, Tier 6 select care drugs are covered with no copay for standard pharmacy and mail-order fills. Tier 1 preferred generics require an $18 copay for a one-month standard supply, while Tier 2 generics have a $19 copay. Higher-tier medications under this plan transition from flat copays to coinsurance. Tier 3 preferred brands and Tier 5 specialty drugs both carry a 25% coinsurance at standard pharmacies and mail-order services. Tier 4 non-preferred drugs require a 31% coinsurance for standard fills.
Additional Benefits
The DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) plan offers robust healthcare coverage featuring no copays for primary care, preventive care, outpatient services, and home health visits. Inpatient acute hospital stays require a $2,230 copay per stay with no coinsurance, while emergency room visits carry a $115 copay that is waived if you are admitted. Specialist visits, diagnostic services, and dialysis require no copay but may subject you to coinsurance ranging from 20% to 50%. For supplemental care, the plan features dental coverage with no copay or coinsurance up to a $3,000 annual limit, alongside a $300 annual allowance for eyewear. Routine hearing exams require no copay with a 50% coinsurance, and up to two prescription hearing aids are covered yearly with copays between $399 and $699. Additionally, skilled nursing facility stays offer no copay for the first 20 days, and members benefit from a $50 quarterly allowance for over-the-counter products.
Inpatient Hospital See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers inpatient acute hospital stays with a $2,230 copay per stay and unlimited additional days, and inpatient psychiatric care with a $2,080 copay per stay, both featuring no coinsurance and requiring prior authorization. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers outpatient services with no copays, though prior authorization is required. Patients will pay between no coinsurance and 50% coinsurance for outpatient hospital and ambulatory surgical services, and a 30% coinsurance for outpatient substance abuse and blood services with no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) with prior authorization, requiring no copay and a coinsurance of no coinsurance to 50% for ground transport and 50% for air transport. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and a 0% to 20% coinsurance (maximum $40 per visit), while worldwide emergency, urgent, and transportation services are covered up to a $25,000 limit with no copay and no coinsurance.
Primary Care See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers primary care physician services with no copay and no coinsurance. Specialist, therapy, psychiatric, and podiatry services are covered with no copay and a 30% coinsurance, while chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) with no copay and no coinsurance for covered care such as annual physicals, fitness benefits, and kidney disease education. Uncovered sub-services include in-home safety assessments, personal emergency response systems (PERS), post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) offers partially covered hearing services, which include routine hearing exams with no copay and a 50% coinsurance, and up to two prescription hearing aids per year with a $399 to $699 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP PLUS 016 OH (HMO C-SNP), featuring no copay, no coinsurance, and no deductible for covered care. This plan covers one routine eye exam per year and up to $300 annually for eyewear, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) with no copay and no coinsurance for most preventive and comprehensive care up to a $3,000 annual limit, while Medicare-covered dental has no copay and a 30% coinsurance. Other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) with no copays for all covered items, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment (DME) and diabetic supplies require a 20% coinsurance, while prosthetics and medical supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers diagnostic and radiological services with no copays, although prior authorization is required for all services. Diagnostic procedures and tests carry no coinsurance, while there is a 20% coinsurance for therapeutic radiological services and a 50% coinsurance for lab services, diagnostic radiological services, and outpatient X-rays.
Home Health Services See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers some cardiac rehabilitation services with no copay, though prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, no prior three-day hospital stay is needed, and additional days beyond Medicare-covered services are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP PLUS 016 OH (HMO C-SNP) with no copay and no coinsurance for over-the-counter items up to $50 every three months, diabetic shoes, and additional preventive services. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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