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DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 020 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 PREMIUM 020 OH (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP PREMIUM 020 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 PREMIUM 020 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 PREMIUM 020 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 PREMIUM 020 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 $5200.00 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 PREMIUM 020 OH (HMO C-SNP) Medicare plan has an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs require an $18 copay for a 1-month supply, while Tier 2 generic drugs have a $20 copay for a 1-month supply at standard pharmacies and standard mail order. Multi-month supplies up to 3 months are also available for these generic tiers at scaled copayment rates. For brand-name and specialty medications, Tier 3 preferred brands require 23% coinsurance and Tier 4 non-preferred drugs require 26% coinsurance. Tier 5 specialty drugs have a 25% coinsurance for a 1-month supply, while Tier 6 select care drugs are available with no copay for 1-month, 2-month, and 3-month fills. These costs apply to both standard pharmacy and standard mail-order services.
Additional Benefits
The DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and preventive care. For specialist visits, patients can expect copays ranging from $40 to $50, while inpatient hospital stays require a $430 daily copay for the first few days with no coinsurance. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital within 24 hours. Ancillary benefits include dental coverage up to $2,000 annually with no copay for preventive services, alongside a $300 yearly allowance for eyewear with no copay. Prescription hearing aids are covered with copays between $399 and $699, and the plan provides up to $50 every three months for over-the-counter items with no copay. Durable medical equipment is covered with coinsurance ranging from 20% to 50% and no copay.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $430 daily copay for days 1 through 6 of acute stays (no copay for days 7 and beyond) and days 1 through 5 of psychiatric stays (no copay for days 6 through 90). Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) with no coinsurance, featuring a copay of $0 to $530 for outpatient hospital services, $430 per stay for observation services, and $40 for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required for most outpatient services.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP), as transportation services to health-related locations are not covered. Covered ground ambulance services require a copay ranging from no copay to $315 plus coinsurance, while air ambulance services require a 20% coinsurance plus a copay, with prior authorization required for both.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have a copay ranging from no copay to $45 with no coinsurance, and worldwide emergency services are covered up to $25,000 with 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 C-SNP PREMIUM 020 OH (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialist, mental health, and physical therapy services require copays ranging from $40 to $50 with no coinsurance. Some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and nutritional therapy. Some services are not covered under this plan, including in-home safety assessments, personal emergency response systems, therapeutic massage, counseling, and adult day health services.
Hearing Services See details
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) partially covers hearing services, offering routine exams for a $40 copay and no coinsurance, and prescription hearing aids with copays ranging from $399 to $699 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 PREMIUM 020 OH (HMO C-SNP), offering one annual routine eye exam with a $0 to $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $300 yearly maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) partially covers dental services up to a $2,000 annual maximum, featuring a $40 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered preventive and comprehensive services. Sub-services that are not covered under this plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) with no copay, though prior authorization is required. Medicare Part B drugs for these services, including chemotherapy and insulin, have a coinsurance ranging from no coinsurance to 20%, with insulin specifically featuring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) partially covers medical equipment with no copay, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment requires 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) with prior authorization required. Diagnostic tests and procedures carry a $0 to $95 copay and no coinsurance, while lab services feature no copay and no coinsurance. Outpatient X-rays have no copay but require coinsurance, diagnostic radiological services have copays starting at $0, and therapeutic radiological services require both a copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) does not cover Cardiac Rehabilitation Services, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) services. Although the plan technically features no coinsurance for this benefit category, these individual services are not covered in practice and require prior authorization.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 020 OH (HMO C-SNP) partially covers other services with no copay and no coinsurance for over-the-counter items up to $50 every three months, diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered.
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