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DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Kansas City Metro/Eastern Kansas. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-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 C-SNP CHOICE PREMIUM 003 KS (PPO C-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 C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.10. 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 combined Maximum Out-Of-Pocket cost of $5900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay an $18 copay for a one-month supply at standard pharmacies and mail-order services, while Tier 2 generic drugs cost a $19 copay. Notably, Tier 6 select care drugs are available with no copay for one, two, or three-month supplies through standard pharmacies and mail order. For higher-tier medications under this plan, cost-sharing transitions to coinsurance. Standard pharmacy and mail-order fills for Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs carry a 33% coinsurance. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply, helping you plan your healthcare expenses effectively.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, while specialist visits and mental health services require a $35 copay. Inpatient hospital stays require a $440 daily copay for the first 5 to 6 days with no copay for subsequent days, and emergency room visits carry a $150 copay. Outpatient services feature no coinsurance, with copays ranging from no copay for ambulatory surgery to a maximum of $540. For supplemental care, the plan features preventive and comprehensive dental benefits up to a $2,000 annual maximum and routine vision exams with no copay. Eyewear is covered with no copay up to a $300 annual allowance, while hearing exams require a $35 copay and prescription hearing aids carry a $399 to $699 copay. Additionally, beneficiaries receive a $50 over-the-counter allowance every three months, and home health services are covered with no copay.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a daily copay of $440 for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) plan are covered with no coinsurance, but prior authorization is required for most services. Copayments range from no copay for ambulatory surgical center and blood services, to a $35 copay for substance abuse sessions, a $440 copay per stay for observation services, and a $0 to $540 copay for outpatient hospital services.
Partial Hospitalization See details
Partial hospitalization is covered by the DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) plan with a $130.00 copay and no coinsurance. Prior authorization is required for this service.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP), with prior-authorized ground ambulance costing a copay ranging from no copay to $340 (and no coinsurance) and air ambulance requiring 20% coinsurance (and no copay). For transportation, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with a $150 copay for emergency and urgent care, and a $340 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist, mental health, and podiatry services require a $35 copay and no coinsurance. Physical and occupational therapy have a $35 to $50 copay and no coinsurance, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) partially covers preventive services with no copay and no coinsurance for covered care, including annual physicals, fitness benefits, and nutritional therapy. Uncovered services under this benefit include in-home safety assessments, personal emergency response systems, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, and counseling services.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) provides partially covered hearing services with no deductible, featuring routine hearing exams for a $35 copay and no coinsurance. Prescription hearing aids are covered with copays ranging from $399 to $699 and no coinsurance, but OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) partially covers vision services, offering one routine eye exam annually with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing a $300 annual maximum allowance for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) offers partially covered dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for most preventive and comprehensive services up to a $2,000 annual maximum. Sub-services that are not covered under this plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical Equipment is covered by DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) with no copays, though prior authorization is required and coinsurance applies to most items. Durable medical equipment incurs a 20% to 50% coinsurance, while prosthetics and medical supplies range from no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with no coinsurance to 50% coinsurance for supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) covers diagnostic and radiological services, with prior authorization required for these benefits. Lab services and outpatient X-rays feature no copay, diagnostic tests and procedures carry a copay of $0 to $95 with no coinsurance, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these fully covered services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) plan with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation (each requiring a $35 copay), and SET for PAD services (requiring a $30 copay) are not covered in practice.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no preceding three-day hospital stay. Beneficiaries pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond this period are not covered.
Other Services See details
DEVOTED C-SNP CHOICE PREMIUM 003 KS (PPO C-SNP) partially covers other services, providing over-the-counter (OTC) items up to $50 every three months, non-Medicare covered diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered.
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