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DEVOTED DUAL 004 AL (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL 004 AL (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED DUAL 004 AL (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL 004 AL (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Central and South Alabama. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED DUAL 004 AL (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED DUAL 004 AL (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED DUAL 004 AL (HMO D-SNP).
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 DUAL 004 AL (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.70. 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 $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 DUAL 004 AL (HMO D-SNP) plan offers an Enhanced Alternative prescription drug benefit with an annual drug deductible of $615.00. During the initial coverage phase, you will pay a 25% coinsurance for Tier 1 through Tier 4 drugs at standard pharmacies and standard mail services. For Tier 5 specialty drugs, this plan features no copay at standard pharmacies and standard mail. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, beneficiaries who qualify for the low-income subsidy will pay a Part D premium of $27.70.
Additional Benefits
The DEVOTED DUAL 004 AL (HMO D-SNP) plan offers comprehensive medical coverage with low out-of-pocket costs, featuring no coinsurance and options for no copay on inpatient hospital stays. Primary care visits, select telehealth services, and preventive care require no copay, while specialist visits carry a $25 copay. Emergency room visits have a $130 copay, which is waived if you are admitted, and outpatient hospital services range from no copay to a $375 copay with no coinsurance. Members also benefit from valuable supplemental services, including routine dental care up to a $1,000 annual limit and a $200 annual eyewear allowance with no copay or deductible. Routine hearing exams require a $25 copay, while prescription hearing aids have copays ranging from $399 to $699. Additionally, the plan provides a $50 quarterly over-the-counter allowance with no copay and covers medical equipment with no copays and coinsurance up to 30%.
Inpatient Hospital See details
DEVOTED DUAL 004 AL (HMO D-SNP) partially covers inpatient hospital benefits with no coinsurance and either no copay for Medicare-covered stays or a $275 copay per day for days 1 to 6 and no copay for days 7 to 90. Non-Medicare-covered stays, upgrades for acute care, and additional days for psychiatric care are not covered, and prior authorization is required.
Outpatient Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center services and a $25 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay of $0 to $375, while observation services carry a $275 copay per stay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED DUAL 004 AL (HMO D-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by DEVOTED DUAL 004 AL (HMO D-SNP), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require prior authorization and a copay of no copay to $325 along with coinsurance, while air ambulance services require a 20% coinsurance and a copay.
Emergency Services See details
Emergency services are covered by DEVOTED DUAL 004 AL (HMO D-SNP) 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 and no coinsurance, while worldwide emergency services are covered up to a $25,000 limit with copays up to $325 and up to 20% coinsurance.
Primary Care See details
DEVOTED DUAL 004 AL (HMO D-SNP) primary care benefits are partially covered with no coinsurance, as routine chiropractic care is not covered. Copays range from no copay for select telehealth and healthcare professionals, $25 for specialists, psychiatric, and podiatry visits, and up to $50 for physical, occupational, and speech therapies.
Preventive Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) partially covers preventive services with no copay and no coinsurance, including annual physicals, fitness benefits, and health education. Sub-services that are not covered under this plan include in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) partially covers hearing services, excluding OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids. Covered routine hearing exams require a $25 copay and no coinsurance, while covered prescription hearing aids require a copay between $399 and $699 with no coinsurance.
Vision Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) covers vision services, featuring annual routine eye exams with a copay ranging from no copay to $25 and no coinsurance. Members also receive a $200 annual allowance for eyewear, such as contacts and eyeglasses, with no deductible, no copay, and no coinsurance.
Dental Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) offers partially covered dental services, which include Medicare-covered dental services for a $25 copay and no coinsurance, and other dental services up to a $1,000 annual maximum. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) covers Home Infusion bundled Services with prior authorization, requiring a $35 copay and coinsurance ranging from no coinsurance to 20% for Medicare Part B insulin drugs. Other covered Part B drugs, including chemotherapy and radiation drugs, require no copay and carry a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) covers dialysis services with a 20% coinsurance and no copay. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED DUAL 004 AL (HMO D-SNP), as diabetic therapeutic shoes and inserts are not covered. Covered services require no copays but are subject to prior authorization, with coinsurance ranging from 20% to 30% for durable medical equipment, no coinsurance to 20% for prosthetics and medical supplies, and no coinsurance to 30% for diabetic supplies.
Diagnostic and Radiological Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) covers diagnostic and radiological services with prior authorization, offering no copay for lab services and outpatient X-rays. Diagnostic procedures and tests carry a copay between $0 and $95, diagnostic radiological services have a copay of up to $300, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED DUAL 004 AL (HMO D-SNP) plan, though prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) technically covers Cardiac Rehabilitation Services, but in practice some services are covered while Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD services are not covered. Any covered services under this benefit require prior authorization and have no copay and no coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by DEVOTED DUAL 004 AL (HMO D-SNP) with prior authorization, featuring no copay or coinsurance for days 1 to 20, and a $218 daily copay with no coinsurance for days 21 to 100. Additional days beyond those covered by Medicare are not covered.
Other Services See details
DEVOTED DUAL 004 AL (HMO D-SNP) partially covers Other Services, providing additional preventive services and a $50 quarterly over-the-counter allowance with no copay or coinsurance. However, acupuncture, meal benefits, and highly integrated services for dual eligible SNPs are not covered under this plan.
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