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Devoted PREMIUM Oregon (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted PREMIUM Oregon (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted PREMIUM Oregon (HMO) in 2025, please refer to our full plan details page.
Devoted PREMIUM Oregon (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 2025.
It's important to know that Devoted PREMIUM Oregon (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 Oregon (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 Oregon (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.70. 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 $590.00 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 Oregon (HMO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and pharmacy used. In the initial coverage phase, you will pay a $10 copay for preferred generic drugs at a standard or mail-order pharmacy. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay 25% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your drugs.
Additional Benefits
The Devoted PREMIUM Oregon (HMO) plan offers a wide range of benefits with varying cost-sharing. You'll find coverage for inpatient hospital stays with a copay, and outpatient services with copays ranging from $0 to $475. Emergency services have a $125 copay, and primary care, including specialist visits, has a $20-$40 copay. This plan also includes coverage for preventive services, hearing and vision care, and dental services, each with specific copays and annual limits. Additional benefits include ambulance services, home health, and skilled nursing facility stays. Be sure to review the details for each service to understand the specific costs, such as copays or coinsurance, and any prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, you'll pay a $375 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you'll pay a $375 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $475, observation services have a $375 copay, and ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted PREMIUM Oregon (HMO) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground Ambulance Services have a copay of $0-$275, while Air Ambulance Services have a 20% coinsurance. Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered by the Devoted PREMIUM Oregon (HMO) plan with a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $45, and no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage with a $125 copay, Worldwide Urgent Coverage with a $125 copay, and Worldwide Emergency Transportation with a $275 copay and 20% coinsurance.
Primary Care See details
The Devoted PREMIUM Oregon (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40-$45 copay, physician specialist services with a $40 copay, mental health specialty services with a $40 copay, other health care professional services with a $0-$40 copay, psychiatric services with a $40 copay, physical therapy and speech-language pathology services with a $40-$50 copay, additional telehealth benefits with a $0-$40 copay, and opioid treatment program services with a $40 copay. Podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services, annual physical exams, health education, weight management programs, alternative therapies, therapeutic massage, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $40 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $199 and $499 for all types, but the plan does not cover inner ear, outer ear, or over the ear prescription hearing aids. OTC hearing aids are not covered.
Vision Services See details
The Devoted PREMIUM Oregon (HMO) plan covers vision services, including routine eye exams with a $40 copay. This plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $2750 per year.
Dental Services See details
Devoted PREMIUM Oregon (HMO) covers dental services, with a $40 copay for Medicare Dental Services, and a $2,750 maximum benefit per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered. Orthodontic Services are covered under Diagnostic and Preventive Dental. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted PREMIUM Oregon (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered by the Devoted PREMIUM Oregon (HMO) plan, including Durable Medical Equipment (DME) with a coinsurance between 0% and 19%, and Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered items. The plan does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and lab services, are covered with a copay of up to $95 for diagnostic procedures/tests and no copay for lab services. Radiological services are covered with a copay of up to $300 for diagnostic radiological services, and a coinsurance of at least 20% for therapeutic radiological services, with no copay for outpatient X-ray services.
Home Health Services See details
Home Health Services are covered by the Devoted PREMIUM Oregon (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted PREMIUM Oregon (HMO) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted PREMIUM Oregon (HMO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include acupuncture and other services. Acupuncture is covered with no copay and no coinsurance, and there is no limit on the number of treatments. Other services, including over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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