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Devoted CORE South Carolina (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CORE South Carolina (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CORE South Carolina (HMO) in 2025, please refer to our full plan details page.
Devoted CORE South Carolina (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 2025.
It's important to know that Devoted CORE South Carolina (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 South Carolina (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 South Carolina (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 $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 $4900.00 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 South Carolina (HMO) plan has an enhanced alternative drug benefit. The plan includes a $590 deductible for prescription drugs. During the initial coverage phase, after you meet your deductible, you may have a $0 copay for preferred generic drugs. For standard generic, preferred brand, and non-preferred drugs, you will pay 25% coinsurance.
Additional Benefits
The Devoted CORE South Carolina (HMO) plan offers a range of benefits with varying costs. Hospital stays have a $295 copay for the first five days, while outpatient services range from no copay to a $395 copay. The plan also includes coverage for hearing, vision, and dental services. This plan covers primary care, preventive services, and home health services, often with low or no copays. The plan also covers ambulance and emergency services, with copays and coinsurance depending on the service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $295 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $395, observation services with a $295 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a $15 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by Devoted CORE South Carolina (HMO), but requires prior authorization. The copay is $60.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Devoted CORE South Carolina (HMO). Ground ambulance services have a copay between $0 and $275, while air ambulance services have 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by Devoted CORE South Carolina (HMO). Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Transportation has a $275 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage both have a $125 copay.
Primary Care See details
The Devoted CORE South Carolina (HMO) plan covers Primary Care Physician Services, Chiropractic Services (with a $15 copay), Occupational Therapy Services (with a $15-$45 copay), Physician Specialist Services (with a $15 copay), Mental Health Specialty Services (with a $15 copay), Other Health Care Professional services (with a $0-$15 copay), Psychiatric Services (with a $15 copay), Physical Therapy and Speech-Language Pathology Services (with a $15-$50 copay), Additional Telehealth Benefits (with a $0-$15 copay), and Opioid Treatment Program Services (with a $15 copay). Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Devoted CORE South Carolina (HMO) plan covers preventive services including Medicare-covered services, annual physical exams, health education, personal emergency response systems, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. However, in-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, and Routine Hearing Exams and Fitting/Evaluation for Hearing Aid are covered. Prescription Hearing Aids (all types) are covered with a copay between $399 and $699, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered; OTC Hearing Aids are also not covered.
Vision Services See details
Vision Services include eye exams with a $10 copay, and also cover eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $1,750 per year.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $15 copay, as well as other dental services with a $1,750 annual maximum benefit. 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. 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 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 25%, and Prosthetics/Medical Supplies - Non-Medicare benefits with a coinsurance, while Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Devoted CORE South Carolina (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $95, and Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $300, Therapeutic Radiological Services have 20% coinsurance, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted CORE South Carolina (HMO) plan with no copay or 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 not covered by the Devoted CORE South Carolina (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CORE South Carolina (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services are not covered, including acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs, 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. Other 2 benefits include $0 preventive services.
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