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DEVOTED CORE 001 OR (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 001 OR (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 001 OR (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 001 OR (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Portland. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 001 OR (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 001 OR (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 001 OR (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 $375.00 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 $5900.00 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 001 OR (HMO) Medicare plan features an annual prescription drug deductible of $375. Tier 1 Preferred Generic drugs are highly affordable with no copay for 1-month, 2-month, or 3-month supplies at standard pharmacies and standard mail order. Tier 2 Generic drugs carry a low copay starting at $5.00 for a 1-month supply, rising to $15.00 for a 3-month standard pharmacy supply and $12.50 for a 3-month mail order. Higher-tier medications are subject to coinsurance rather than flat copays. Tier 3 Preferred Brand drugs require a 24% coinsurance, and Tier 4 Non-Preferred drugs require a 25% coinsurance for 1-month, 2-month, and 3-month supplies. Tier 5 Specialty Tier drugs require a 28% coinsurance for a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED CORE 001 OR (HMO) plan offers robust medical coverage featuring no copay for primary care visits and a $40 copay for specialists, with no coinsurance for either. Inpatient hospital stays require a $375 daily copay for the first five days and no copay for subsequent days, while emergency room visits carry a $130 copay that is waived if you are admitted. Outpatient hospital services and diagnostic lab tests are also highly affordable, often requiring no copay and no coinsurance. For ancillary care, the plan provides preventive dental services with no copay or coinsurance up to a $2,000 annual maximum, plus a $400 annual allowance for eyewear with no copay. Hearing benefits include routine exams for a $40 copay and prescription hearing aid copays ranging from $399 to $699. Members also receive home health services with no copay and a $40 quarterly over-the-counter allowance to help manage everyday health needs.
Inpatient Hospital See details
Inpatient hospital care is partially covered by DEVOTED CORE 001 OR (HMO) with no coinsurance, requiring a $375 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 001 OR (HMO) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $475 copay and observation services with a $375 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay, while outpatient substance abuse sessions require a $40 copay.
Partial Hospitalization See details
DEVOTED CORE 001 OR (HMO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
DEVOTED CORE 001 OR (HMO) covers ambulance services with prior authorization, requiring a copay of $0 to $315 and no coinsurance for ground ambulance services, and a 20% coinsurance with no copay for air ambulance services. Transportation services are not covered.
Emergency Services See details
Emergency services are covered by DEVOTED CORE 001 OR (HMO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $45 copay with no coinsurance, while 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 CORE 001 OR (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Primary care benefits are partially covered, excluding podiatry and non-routine chiropractic services, but including mental health, telehealth, and physical therapy with copays ranging from $0 to $50 and no coinsurance.
Preventive Services See details
DEVOTED CORE 001 OR (HMO) provides partially covered preventive services, offering annual physicals, kidney disease education, and diabetes training with no copay and no coinsurance. Additional benefits like fitness and nutritional programs have no copay, though therapeutic massage and alternative therapies carry up to 50% coinsurance, and services such as in-home safety assessments and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED CORE 001 OR (HMO), featuring routine hearing exams for a $40 copay and no coinsurance, and up to two prescription hearing aids per year with copays 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 under DEVOTED CORE 001 OR (HMO), offering routine eye exams 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 $400 annual maximum benefit for contacts, eyeglasses, and upgrades.
Dental Services See details
DEVOTED CORE 001 OR (HMO) dental services are covered up to a $2,000 annual maximum, featuring no copay and no coinsurance for preventive care, and no copay with 0% to 50% coinsurance for restorative, endodontic, and prosthodontic services. Medicare-covered dental services require a $40 copay and no coinsurance, but the benefit is only partially covered as maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 001 OR (HMO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry a 0% to 20% coinsurance, while Medicare Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the DEVOTED CORE 001 OR (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CORE 001 OR (HMO) covers medical equipment with no copays and prior authorization required, featuring 20% to 50% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no coinsurance to 50% coinsurance for diabetic supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CORE 001 OR (HMO) with prior authorization, offering no coinsurance and no copay for lab services, alongside a $0 to $95 copay for diagnostic procedures. Radiological services feature no copay for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered by DEVOTED CORE 001 OR (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered under the DEVOTED CORE 001 OR (HMO) plan with no coinsurance, though prior authorization is required. However, key sub-services—including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CORE 001 OR (HMO) with no coinsurance, featuring 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 inpatient hospital stay is needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED CORE 001 OR (HMO) offers partial coverage for other services, including unlimited acupuncture with no copay and 50% coinsurance, additional preventive services with no copay or coinsurance, and a $40 quarterly over-the-counter allowance with no copay or coinsurance. Meal benefits are not covered under this plan.
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