A non-government entity
DEVOTED C-SNP CHOICE PLUS 004 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 PLUS 004 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 PLUS 004 KS (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PLUS 004 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. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PLUS 004 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 PLUS 004 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 PLUS 004 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 PLUS 004 KS (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $42.80. 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 has a $900.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $13900.00 (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 $13900.00 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:
Sign up for DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 6 select care drugs filled through standard pharmacies or standard mail order. For other generic medications, a one-month supply costs an $18 copay for Tier 1 preferred generics and a $19 copay for Tier 2 generics. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Standard pharmacy and mail-order fills require a 25% coinsurance for Tier 3 preferred brands and a 31% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty drugs are also covered at a 25% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) plan offers robust medical coverage with no copays for primary care visits, home health, and outpatient services, though coinsurance up to 50% may apply to outpatient care. Inpatient hospital stays require a set copay of $2,230 for acute care or $2,080 for psychiatric care, while emergency room visits carry a $115 copay that is waived upon admission. Skilled nursing care is also covered, featuring no copay for the first 20 days and a $218 daily copay for days 21 through 100. For extra wellness benefits, the plan provides a generous $3,000 annual dental maximum and a $300 yearly eyewear allowance with no copays or coinsurance for routine care. Routine hearing and vision exams also feature no copays, though coinsurance up to 50% applies, and prescription hearing aids require a copay between $399 and $699. Additionally, members can take advantage of a $50 over-the-counter allowance every three months with no copay or coinsurance.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) partially covers inpatient hospital services, with acute care requiring a $2,230 copay per stay and psychiatric care requiring a $2,080 copay per stay, both with no coinsurance. Prior authorization is required for these services, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) with no copays, though coinsurance ranging from no coinsurance up to 50% applies to hospital, observation, and ambulatory surgical center services. Outpatient substance abuse and blood services also require no copays but carry a 30% coinsurance, with prior authorization required for most services.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) covers ambulance services with no copay, requiring between no coinsurance and 50% coinsurance for ground services and a 50% coinsurance for air services. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay and a 0% to 20% coinsurance (up to a $40 maximum per visit), while worldwide emergency, urgent, and transportation services are covered up to $25,000 with no copay and no coinsurance.
Primary Care See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) provides primary care physician services with no copay and no coinsurance. Most other primary care benefits, including specialist visits, physical therapy, and mental health services, are covered with no copay and 30% coinsurance, though routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) with no copay and no coinsurance for covered options like annual physical exams and fitness benefits. Some sub-services are not covered, including in-home safety assessments, personal emergency response systems (PERS), therapeutic massage, and home-based palliative care.
Hearing Services See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) covers annual routine hearing exams with no copay and a 50% coinsurance, alongside hearing aid fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $399 to $699 for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) provides partially covered vision services, offering one routine eye exam per year with no copay and 0% to 50% coinsurance, while other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, is available with no copay and no coinsurance up to a combined maximum benefit of $300 per year.
Dental Services See details
Dental Services are partially covered by DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP), offering up to a $3,000 annual maximum benefit for both in- and out-of-network care. Medicare-covered dental services require no copay and 30% coinsurance, while other covered preventive and comprehensive services have no copay and no coinsurance; however, other diagnostic services, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy, radiation, and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment and diabetic supplies require a 20% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) with prior authorization required and no copays. Under this plan, diagnostic procedures and tests have no coinsurance, while therapeutic radiology has a 20% coinsurance, and lab services, diagnostic radiology, and outpatient X-rays require a 50% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but prior authorization is required. In practice, key sub-services are not covered, including Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for PAD, which all carry a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) covers skilled nursing facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior 3-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED C-SNP CHOICE PLUS 004 KS (PPO C-SNP) partially covers other services with no copay and no coinsurance, including over-the-counter (OTC) items up to $50 every three months, non-Medicare covered diabetic shoes, and additional preventive services. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved