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DEVOTED CORE 022 OH (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 022 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 022 OH (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 022 OH (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Northern Ohio. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 022 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 022 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 022 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 $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 CORE 022 OH (HMO) Medicare plan features an annual drug deductible of $175. For prescription drug coverage, beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order. This makes managing everyday medications highly affordable under this plan. For higher-tier medications, costs are shared through coinsurance rather than set copayments. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for standard pharmacy and mail-order fills. Specialty Tier 5 medications are covered with a 30% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CORE 022 OH (HMO) Medicare plan provides robust healthcare coverage featuring no copay and no coinsurance for primary care doctor visits and covered preventive services. Specialists and urgent care visits require copays ranging from no copay to $50, while emergency room services carry a $130 copay with no coinsurance. For inpatient hospital stays, members pay a daily copay of $395 for the first few days and no copay for subsequent days, with no coinsurance. Supplemental benefits include dental care up to a $3,500 annual limit, offering preventive care with no copay and comprehensive services with 0% to 50% coinsurance. Vision and hearing benefits feature low copays, including a $35 exam copay for hearing and an annual eyewear allowance of up to $350 with no copay, coinsurance, or deductible. Members also benefit from a $125 over-the-counter allowance every three months and home health services, both of which require no copay and no coinsurance.
Inpatient Hospital See details
DEVOTED CORE 022 OH (HMO) covers inpatient hospital services with no coinsurance, requiring a $395 daily copay for days 1 through 6 of acute stays and days 1 through 5 of psychiatric stays, followed by no copay for subsequent days. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient Services under DEVOTED CORE 022 OH (HMO) are covered with no coinsurance, featuring a $0 to $495 copay for outpatient hospital services and a $395 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are offered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
DEVOTED CORE 022 OH (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required before you can receive these services.
Ambulance and Transportation Services See details
Ambulance services under DEVOTED CORE 022 OH (HMO) require prior authorization, offering ground ambulance services with a copay of $0 to $315 and air ambulance services with a 20% coinsurance. Routine transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED CORE 022 OH (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a copay of no copay to $45 and no coinsurance. Worldwide emergency services are covered up to a $25,000 lifetime maximum, with a $130 copay and no coinsurance for emergency and urgent care, and a $315 copay alongside 20% coinsurance for emergency transportation.
Primary Care See details
Primary care benefits are partially covered under DEVOTED CORE 022 OH (HMO), excluding podiatry and chiropractic services. Covered services feature no copay and no coinsurance for primary care physician visits, while specialist, therapy, mental health, psychiatric, and telehealth services require copays ranging from $0 to $50 and no coinsurance.
Preventive Services See details
Preventive services are partially covered by DEVOTED CORE 022 OH (HMO) with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and kidney disease education. However, several services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are covered by DEVOTED CORE 022 OH (HMO), featuring a $35 copay and no coinsurance for hearing exams, which require prior authorization. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699, though 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 partially covered by DEVOTED CORE 022 OH (HMO) because other eye exam services are not covered. Routine eye exams are covered once per year with a $0 to $35 copay and no coinsurance, and eyewear is covered with no copay, no coinsurance, and no deductible up to a $350 annual limit.
Dental Services See details
DEVOTED CORE 022 OH (HMO) partially covers dental services up to a $3,500 annual maximum, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and 0% to 50% coinsurance. Medicare-covered dental services require a $35 copay and no coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 022 OH (HMO) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CORE 022 OH (HMO) with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
DEVOTED CORE 022 OH (HMO) partially covers medical equipment with no copays, though prior authorization is required. Durable medical equipment requires a 20% to 50% coinsurance, prosthetic devices 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
Diagnostic and radiological services are covered by DEVOTED CORE 022 OH (HMO) with prior authorization required. Diagnostic tests have a $0 to $95 copay with no coinsurance, lab services and outpatient X-rays have no copay, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CORE 022 OH (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CORE 022 OH (HMO) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, specific sub-services—including cardiac, intensive cardiac, and pulmonary rehabilitation (each with a $35 copay), as well as supervised exercise therapy (SET) for peripheral artery disease (PAD) services (with a $25 copay)—are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 022 OH (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Members pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED CORE 022 OH (HMO), excluding acupuncture and meal benefits. Covered options include additional preventive services and over-the-counter (OTC) items up to $125 every three months, both of which feature no copay and no coinsurance.
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