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DEVOTED CORE 003 OR (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 003 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 003 OR (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 003 OR (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Eugene. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 003 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 003 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 003 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 $595.00 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 003 OR (HMO) plan features an annual prescription drug deductible of $595. For Tier 1 preferred generic and Tier 2 generic drugs, there is no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. For higher-tier medications, cost-sharing is based on coinsurance at standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 24% coinsurance for one-, two-, or three-month supplies. Tier 4 non-preferred drugs require a 25% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CORE 003 OR (HMO) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits, copays range from $40 to $50, while emergency services carry a $130 copay that is waived upon hospital admission. If hospital care is required, inpatient stays cost $425 per day for the first four days with no copay for days five through 90, and skilled nursing facility stays feature no copay for the first 20 days. This plan also includes key supplemental benefits to help manage your everyday healthcare costs. Dental services are covered up to a $1,500 annual maximum with no copay or coinsurance for preventive care, while vision benefits provide an annual routine eye exam and up to $300 yearly for eyewear with no copay. Additionally, the plan covers routine hearing exams for a $40 copay, prescription hearing aids with copays starting at $399, and an over-the-counter benefit of up to $40 every three months with no copay.
Inpatient Hospital See details
DEVOTED CORE 003 OR (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $425 per day for days 1 through 4, and no copay for days 5 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 003 OR (HMO) covers outpatient services with no coinsurance, featuring copays ranging from $0 to $525 for outpatient hospital services and a $425 copay per stay for observation services. Outpatient substance abuse sessions have a $40 copay with no coinsurance, while ambulatory surgical center and outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CORE 003 OR (HMO) with a $70.00 copay and no coinsurance, but prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED CORE 003 OR (HMO) covers ground ambulance services with a copay of $0 to $310 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED CORE 003 OR (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services cost between no copay and a $45 copay with no coinsurance, while worldwide emergency services are covered up to $25,000 with a $130 copay for emergency or urgent care, and a $310 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 003 OR (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, mental health sessions, and physical, occupational, or speech therapies have copays ranging from $40 to $50 with no coinsurance. Routine chiropractic care is covered with a $15 copay and no coinsurance for up to 12 visits per year, but podiatry and other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED CORE 003 OR (HMO) with no copay and no coinsurance for annual physicals, kidney education, and routine screenings, though alternative therapies and therapeutic massages require a coinsurance of up to 50%. This benefit is partially covered, as in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling are not covered.
Hearing Services See details
Hearing services are covered by DEVOTED CORE 003 OR (HMO), including one routine hearing exam per year for a $40 copay and no coinsurance, with no deductible. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two devices per year, while OTC hearing aids and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CORE 003 OR (HMO), excluding other eye exam services but offering one annual routine eye exam with no coinsurance and a copay ranging from no copay to $40. Eyewear is covered with no copay or coinsurance up to a $300 yearly maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CORE 003 OR (HMO) dental services are partially covered, offering up to a $1,500 annual maximum with no copay and no coinsurance for preventive care, periodontics, and oral surgery. Restorative, endodontic, and prosthodontic services require no copay and 0% to 50% coinsurance, while Medicare-covered dental services have a $40 copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered by the plan.
Home Infusion bundled Services See details
DEVOTED CORE 003 OR (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and insulin, require coinsurance ranging from no coinsurance to 20%, with insulin specifically carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CORE 003 OR (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical Equipment is partially covered by DEVOTED CORE 003 OR (HMO) with no copays, though prior authorization is required. Durable medical equipment carries a 17% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 17% 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 003 OR (HMO) with prior authorization required, offering no copay or coinsurance for lab services. Diagnostic procedures feature a $0 to $95 copay with no coinsurance, outpatient X-rays have no copay (coinsurance applies), and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CORE 003 OR (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CORE 003 OR (HMO) with no coinsurance, though prior authorization is required. Some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, carrying copayments of $40, $40, $35, and $25 respectively.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 003 OR (HMO) covers Skilled Nursing Facility (SNF) services 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, a prior 3-day hospital stay is not needed, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
DEVOTED CORE 003 OR (HMO) partially covers Other Services, offering acupuncture with no copay and 50% coinsurance, as well as over-the-counter items and additional preventive services with no copay and no coinsurance. Meal benefits are not covered under this plan, and the over-the-counter benefit is capped at $40 every three months.
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