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DEVOTED CORE 001 SC (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 001 SC (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 SC (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 001 SC (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in South Carolina. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 001 SC (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 SC (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 SC (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 $370.00 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 SC (HMO) medicare plan features an annual prescription drug deductible of $370. Under this plan, there is no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs filled at standard pharmacies or through standard mail order for 1-month, 2-month, or 3-month supplies. This coverage makes routine generic medications highly affordable for members. For higher-tier medications, costs are determined by coinsurance rather than set copays. Tier 3 (Preferred Brand) drugs require a 24% coinsurance, and Tier 4 (Non-Preferred) drugs require a 25% coinsurance for standard pharmacy and mail-order fills. Additionally, Tier 5 (Specialty) drugs carry a 28% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED CORE 001 SC (HMO) Medicare plan provides robust coverage with predictable out-of-pocket costs, including no copay for primary care visits, annual physicals, and home health services. Specialist visits require a low $25 copay, while inpatient hospital stays cost a $295 daily copay for the first five days and no copay for days six through 90. Emergency room visits carry a $130 copay, which is waived if you are admitted, and there is no coinsurance for inpatient, outpatient, or emergency services. For additional wellness needs, the plan features no deductibles and offers generous allowances, such as a $1,750 annual maximum for dental care and a $300 annual limit for eyewear with no copays. Routine hearing exams require a $25 copay, while prescription hearing aids have copays ranging from $399 to $699. Medical equipment and Part B drugs do not require copays, though they may carry coinsurance ranging from 20% to 50% depending on the specific service or item.
Inpatient Hospital See details
DEVOTED CORE 001 SC (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED CORE 001 SC (HMO) outpatient services are covered with no coinsurance, featuring copays ranging from $0 to $395 for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions carry a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CORE 001 SC (HMO) with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED CORE 001 SC (HMO), featuring ground ambulance services with a copay ranging from no copay to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Although transportation services are technically covered, some services are not covered in practice, including transportation to plan-approved health-related locations and any other health-related locations.
Emergency Services See details
DEVOTED CORE 001 SC (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 are covered with a copay ranging from no copay to $45 and 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 plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 001 SC (HMO) covers primary care visits with no copay and no coinsurance, and specialist visits for a $25 copay and no coinsurance. Physical therapy, mental health, and telehealth services are covered with copays up to $50 and no coinsurance, though podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
DEVOTED CORE 001 SC (HMO) preventive services are partially covered with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and nutritional counseling. Specific sub-services are not covered under this benefit, including personal emergency response systems (PERS), medical nutrition therapy, therapeutic massage, and in-home support services.
Hearing Services See details
DEVOTED CORE 001 SC (HMO) provides partially covered hearing services, featuring a $25 copay and no coinsurance for one annual routine hearing exam, and up to two prescription hearing aids per year with a copay ranging from $399 to $699 and no coinsurance. However, OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered by the plan.
Vision Services See details
Vision Services are partially covered by DEVOTED CORE 001 SC (HMO) with no deductibles, offering one routine eye exam per year with a $0 to $25 copay and no coinsurance, though other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance up to a $300 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 001 SC (HMO) with a $1,750 annual maximum, offering no copay and no coinsurance for most preventive and comprehensive care like cleanings, exams, and endodontics. Medicare-covered dental services require a $25 copay and no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CORE 001 SC (HMO) with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CORE 001 SC (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CORE 001 SC (HMO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment has a 20% to 50% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with no coinsurance to 50% coinsurance for supplies while therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 001 SC (HMO) covers diagnostic services with no coinsurance, featuring a $0 to $95 copay for tests and no copay for lab services. Radiological services require prior authorization and feature a $0 minimum copay for diagnostic radiology, no copay for outpatient X-rays, and a 20% minimum coinsurance for therapeutic radiological services.
Home Health Services See details
DEVOTED CORE 001 SC (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CORE 001 SC (HMO) provides cardiac rehabilitation services with no coinsurance and prior authorization, meaning some services are covered. However, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $25 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED CORE 001 SC (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients 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 limit are not covered.
Other Services See details
DEVOTED CORE 001 SC (HMO) partially covers Other Services, offering Over-the-Counter (OTC) items and additional preventive services with no copay and no coinsurance. However, acupuncture and meal benefits are not covered under this plan.
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