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DEVOTED PREMIUM 005 OR (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED PREMIUM 005 OR (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED PREMIUM 005 OR (HMO) in 2026, please refer to our full plan details page.
DEVOTED PREMIUM 005 OR (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Oregon. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED PREMIUM 005 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 PREMIUM 005 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 PREMIUM 005 OR (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $43.20. 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 $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 Premium 005 OR (HMO) Medicare plan features an annual prescription drug deductible of $615. Tier 1 preferred generic drugs are fully covered with no copay for one-, two-, or three-month supplies at standard pharmacies and standard mail-order services. For Tier 2 generic drugs, copays are as low as $3 for a one-month supply, rising to $9 for a three-month supply at standard pharmacies or $7.50 via standard mail order. Higher-tier medications are subject to coinsurance rather than flat copays during the initial coverage phase. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs both require a 25% coinsurance. These cost-sharing rates apply to standard retail pharmacies and standard mail-order services, helping you plan your healthcare expenses with the Devoted Premium 005 OR (HMO) plan.
Additional Benefits
The DEVOTED PREMIUM 005 OR (HMO) plan offers robust medical coverage with no copays for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $375 for the first five days and no copay for subsequent days, while specialist visits require a copay between $40 and $50. Emergency care is available with a $130 copay, which is waived if admitted, and urgent care ranges from no copay to a $45 copay. This plan also includes valuable supplemental benefits, featuring preventive dental care with no copay and up to a $3,000 annual limit for comprehensive services. Vision and hearing needs are supported with routine eye exams, a $400 annual eyewear allowance, and prescription hearing aids starting at a $199 copay. Additionally, skilled nursing facility stays require no copay for the first 20 days, and members receive up to $40 every three months for over-the-counter items.
Inpatient Hospital See details
DEVOTED PREMIUM 005 OR (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $375 daily copay for days 1 to 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, though unlimited additional acute care days are provided.
Outpatient Services See details
DEVOTED PREMIUM 005 OR (HMO) covers outpatient services with no coinsurance, though prior authorization is required for most treatments. Patients will pay a $0 to $475 copay for outpatient hospital services, a $375 copay per stay for observation services, a $40 copay for outpatient substance abuse sessions, and no copay for ambulatory surgical center or outpatient blood services.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED PREMIUM 005 OR (HMO) with a $70.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED PREMIUM 005 OR (HMO) with prior authorization, featuring a copay of $0 to $315 plus coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered under the DEVOTED PREMIUM 005 OR (HMO) plan with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay to a $45 copay with no coinsurance, and worldwide emergency services are covered up to a $25,000 limit with a $130 copay for emergency or urgent care and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED PREMIUM 005 OR (HMO) covers primary care physician services with no copay and no coinsurance, while specialist, mental health, and therapy services require copays ranging from $40 to $50 and no coinsurance. Chiropractic services are partially covered with a $15 copay for routine care (other chiropractic services are not covered), telehealth is available with a $0 to $45 copay and no coinsurance, and podiatry services are not covered.
Preventive Services See details
DEVOTED PREMIUM 005 OR (HMO) preventive services are partially covered, offering annual physical exams, kidney disease education, and routine screenings with no copay and no coinsurance. While supplemental benefits like fitness and weight management feature no copay and no coinsurance, alternative therapies and therapeutic massage require up to 50% coinsurance. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, adult day health, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
DEVOTED PREMIUM 005 OR (HMO) partially covers hearing services, offering routine hearing exams for a $40 copay and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are covered with no coinsurance and copays ranging from $199 to $499, but OTC hearing aids and inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
DEVOTED PREMIUM 005 OR (HMO) provides partially covered vision services, as other eye exam services are not covered. One routine eye exam per year is covered with a $0 to $40 copay and no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $400 annual maximum.
Dental Services See details
Dental services are partially covered by DEVOTED PREMIUM 005 OR (HMO) with up to a $3,000 annual limit, offering preventive care, exams, and cleanings with no copay and no coinsurance. Medicare-covered dental has a $40 copay and no coinsurance, while other covered services have no copay and 0% to 50% coinsurance, excluding orthodontics, implant services, and maxillofacial prosthetics which are not covered.
Home Infusion bundled Services See details
DEVOTED PREMIUM 005 OR (HMO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the DEVOTED PREMIUM 005 OR (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
DEVOTED PREMIUM 005 OR (HMO) covers medical equipment with no copay, though prior authorization is required and coinsurance ranges from no coinsurance up to 20% depending on the service. While durable medical equipment and prosthetics are covered, diabetic equipment is only partially covered as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED PREMIUM 005 OR (HMO) with prior authorization required. Diagnostic services have no coinsurance, featuring no copay for lab services and a copay of $0 to $95 for procedures, while radiological services include outpatient X-rays with no copay, diagnostic radiology starting at a $0 copay, and therapeutic radiology with a minimum 20% coinsurance and a copay.
Home Health Services See details
DEVOTED PREMIUM 005 OR (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the DEVOTED PREMIUM 005 OR (HMO) plan with no coinsurance, although only some services are covered in practice while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Prior authorization is required for these services, which carry copayments ranging from $25 to $40.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED PREMIUM 005 OR (HMO) 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 the standard 100-day Medicare limit are not covered.
Other Services See details
DEVOTED PREMIUM 005 OR (HMO) covers acupuncture with no copay and 50% coinsurance, as well as over-the-counter (OTC) items and additional preventive services with no copay and no coinsurance. While OTC items are covered up to $40 every three months, meal benefits are not covered under this plan.
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