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DEVOTED C-SNP CHOICE PREMIUM 007 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 007 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 007 KS (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 007 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 River Valley Area. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 007 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 007 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 007 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 007 KS (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.90. 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 007 KS (PPO C-SNP) plan features an annual drug deductible of $615. For Tier 6 select care drugs, there is no copay for up to a three-month supply filled through standard pharmacies or standard mail order. Tier 1 preferred generic drugs require an $18 copay for a one-month supply, while Tier 2 generic drugs carry a $19 copay for a one-month supply. Higher-tier medications require coinsurance rather than a flat copay at standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 21% coinsurance, and Tier 4 non-preferred drugs have a 33% coinsurance for all supply durations. Tier 5 specialty drugs are limited to a one-month supply and carry a 25% coinsurance.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) plan offers robust medical coverage, featuring no copay or coinsurance for primary care visits, home health services, and routine preventive care. For hospital care, inpatient stays require a $375 daily copay for days 1 through 6, with no copay for days 7 through 90. Outpatient hospital services require a copay of up to $475, while other outpatient care like ambulatory surgical centers and lab services are available with no copay. Supplemental benefits include vision coverage with no copay for eyewear up to a $300 annual limit, and dental care with no copay up to a $2,000 annual maximum. Routine hearing exams carry a $30 copay, while prescription hearing aids require copays ranging from $399 to $699. Additionally, members receive a $50 over-the-counter allowance every three months with no copay, and emergency room visits require a $150 copay that is waived if admitted within 24 hours.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) inpatient hospital benefits are partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Covered acute and psychiatric stays require a $375 daily copay for days 1 through 6 and no copay for days 7 through 90, with no coinsurance.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of up to $475 (or $375 per stay for observation services), while outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered under the DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) plan with a $130.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP), offering ground ambulance services with a copay of up to $350 (and no coinsurance) and air ambulance services with a 20% coinsurance (and no copay). Prior authorization is required for ambulance services, and transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 007 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 require no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with copays ranging from $150 to $350 and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) covers primary care physician services with no copay and no coinsurance, and offers telehealth benefits with a $0 to $45 copay and no coinsurance. Other services like specialist visits, mental health, therapy, and podiatry require no coinsurance with copays ranging from $0 to $50, while chiropractic services are only partially covered since routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by the DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) with no copay and no coinsurance for covered options like annual physicals, nutrition therapy, and fitness benefits. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems (PERS), post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) partially covers hearing services, offering one annual routine hearing exam for a $30 copay and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are covered with no coinsurance and copays ranging from $399 to $699, but over-the-counter hearing aids, as well as inner ear, outer ear, and over-the-ear prescription models, are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) offers partially covered vision services, including one annual routine eye exam with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, offering an annual combined maximum benefit of $300 for contact lenses, eyeglasses, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) offers partially covered dental services, featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $2,000 annual maximum. Orthodontics, implant services, maxillofacial prosthetics, other diagnostic dental services, and other preventive dental services are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered by DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) with no copays, though prior authorization is required. Durable medical equipment carries a 20% to 50% coinsurance, while prosthetics and medical supplies require no coinsurance to 20% coinsurance. Diabetic equipment is partially covered, offering diabetic supplies with no coinsurance to 50% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic procedures have no coinsurance and a copay of $0 to $95, while lab services and outpatient X-rays have no copay, diagnostic radiology has a copay starting at $0, and therapeutic radiology requires a minimum 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) plan with no coinsurance, but only some services are covered in practice as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $30 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) covers skilled nursing facility (SNF) services with no coinsurance and no prior three-day hospital stay requirement. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the standard 100-day limit are not covered.
Other Services See details
DEVOTED C-SNP CHOICE PREMIUM 007 KS (PPO C-SNP) partially covers other services with no copay and no coinsurance for over-the-counter (OTC) items up to $50 every three months, non-Medicare diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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