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Devoted CORE North Carolina (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CORE North 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 North Carolina (HMO) in 2025, please refer to our full plan details page.
Devoted CORE North Carolina (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in North Carolina Triad. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Devoted CORE North 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 North 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 North 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 $3600.00 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 North Carolina (HMO) plan has an "Enhanced Alternative" drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. Preferred Generic drugs have no copay at standard and mail-order pharmacies. Standard Generic, Preferred Brand, and Non-Preferred drugs have a 25% coinsurance at standard and mail-order pharmacies. After your total drug costs reach $2000.00, you will enter the catastrophic coverage phase, where you will pay nothing for Part D covered drugs.
Additional Benefits
The Devoted CORE North Carolina (HMO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services can range from no copay to $395. Emergency services have a copay, and primary care, including specialist visits, mental health, and therapy, typically have a $15 copay. Preventive services are covered with no copay, while hearing and vision services have annual limits and copays. Dental services are covered up to $1500 per year, and home health services have no copay. The plan also covers home infusion, dialysis, medical equipment, and diagnostic services, each with specific copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $295 for days 1-5 and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $395, and observation services have a $295 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $15 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted CORE North Carolina (HMO) plan with a $60 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted CORE North Carolina (HMO) plan. Ground ambulance services have a copay between $0 and $290, while air ambulance services have a 20% coinsurance, and 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 under the Devoted CORE North Carolina (HMO) plan. Emergency Services have a $140 copay, and no coinsurance, while Urgently Needed Services have a copay between $0-$45, and no coinsurance. Worldwide Emergency Transportation has a $290 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $140 copay, and no coinsurance.
Primary Care See details
The Devoted CORE North Carolina (HMO) plan covers primary care physician services, chiropractic services with a $15 copay for routine care, occupational therapy with a $15-$50 copay, physician specialist services with a $15 copay, mental health and 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. Podiatry services are not covered.
Preventive Services See details
The Devoted CORE North 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 and Modifications, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs with no copay. In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services are not covered.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is unlimited. Prescription hearing aids are covered with a copay between $399 and $699, limited to 2 visits per year, but prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Devoted CORE North Carolina (HMO) plan covers vision services, including routine eye exams with 1 visit per year, and eyewear with a combined maximum benefit of $1500 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $15 copay, as well as other dental services including 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. Maxillofacial prosthetics, implant services, and orthodontics are not covered. This plan has a maximum benefit of $1500 per year for dental services.
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, there is between 0% and 20% coinsurance. For Other Medicare Part B Drugs, there is between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted CORE North Carolina (HMO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the Devoted CORE North Carolina (HMO) plan, including Durable Medical Equipment (DME) with 0-30% coinsurance and Prosthetic Devices with 0-20% coinsurance, but Durable Medical Equipment for use outside the home is not covered; Medical Supplies have a 20% coinsurance. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $95, lab services with no copay, diagnostic radiological services with a copay up to $300, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-ray services with no copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted CORE North Carolina (HMO) plan, but the plan does not cover any of the sub-services. There is a copay for some Cardiac and Pulmonary Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Devoted CORE North Carolina (HMO). For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services are not covered by the Devoted CORE North Carolina (HMO) plan, including acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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.
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