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DEVOTED CORE 001 NC (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 001 NC (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 001 NC (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 001 NC (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 5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 001 NC (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 001 NC (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 001 NC (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 $395.00 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 001 NC (HMO) Medicare plan features an annual prescription drug deductible of $395. Beneficiaries enjoy no copay for Tier 1 preferred generic drugs filled at standard pharmacies or through standard mail order for any supply length. Tier 2 generic medications require a low copay, starting at $5.00 for a one-month supply and reaching up to $15.00 for a three-month standard retail supply or $12.50 for a three-month standard mail order. For higher-tier medications, costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs and Tier 4 non-preferred drugs both carry a 25% coinsurance for one-, two-, or three-month supplies at standard retail and mail-order pharmacies. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply at standard retail or mail-order pharmacies, with multi-month supplies not covered.
Additional Benefits
The DEVOTED CORE 001 NC (HMO) plan offers affordable medical coverage featuring no copay for primary care visits, home health care, and routine lab tests or X-rays. Specialist visits require a $25 copay, while inpatient hospital stays require a $295 daily copay for days one through five and no copay for days six through ninety. Outpatient hospital services feature a copay ranging from no copay to $395, and emergency room visits carry a $150 copay that is waived upon admission. For additional wellness services, the plan provides dental care with no copay up to a $1,500 annual maximum and eyewear with no copay up to a $200 yearly limit. Routine eye exams range from no copay to a $25 copay, while routine hearing exams require a $25 copay. Additionally, durable medical equipment, dialysis, and Medicare Part B drugs feature no copays but require a coinsurance ranging up to 20% or 50%.
Inpatient Hospital See details
DEVOTED CORE 001 NC (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copayment for days 1 through 5 and no copayment for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 001 NC (HMO) outpatient services are covered with no coinsurance, featuring a $0 to $395 copay for outpatient hospital services and a $295 copay per stay for observation services. Ambulatory surgical center and blood services have no copay, while individual and group outpatient substance abuse sessions require a $25 copay.
Partial Hospitalization See details
DEVOTED CORE 001 NC (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
DEVOTED CORE 001 NC (HMO) covers ambulance services with prior authorization, offering ground ambulance services with a copay of $0 to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 001 NC (HMO) 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 a $150 copay for care and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 001 NC (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits for a $25 copay and no coinsurance. Most other covered services, including therapy, mental health, and telehealth, feature copays ranging from $0 to $50 with no coinsurance, while podiatry is not covered and chiropractic has some services covered but routine and other chiropractic services are not covered.
Preventive Services See details
DEVOTED CORE 001 NC (HMO) features partially covered preventive services with no copay and no coinsurance for covered care, including annual physical exams, fitness benefits, and kidney disease education. Note that some sub-services are not covered, such as in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, therapeutic massage, adult day health, and home-based palliative care.
Hearing Services See details
Hearing services are partially covered by DEVOTED CORE 001 NC (HMO), offering routine hearing exams for a $25 copay and no coinsurance, and up to two prescription hearing aids per year for a $399 to $699 copay and no coinsurance. OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED CORE 001 NC (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $25 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including contacts, frames, lenses, and upgrades, has no copay and no coinsurance up to a $200 annual maximum.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 001 NC (HMO), offering Medicare-covered dental care for a $25 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $1,500 annual maximum. While many preventive and comprehensive services are covered, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 001 NC (HMO) covers home infusion bundled services with no copay, though prior authorization is required and Part D home infusion drugs are not covered under this bundle. Covered Medicare Part B drugs, including chemotherapy and insulin, feature a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the DEVOTED CORE 001 NC (HMO) plan with no copay and a 20% coinsurance, and prior authorization is required.
Medical Equipment See details
DEVOTED CORE 001 NC (HMO) partially covers medical equipment with no copays, featuring 20% to 50% coinsurance for durable medical equipment, no coinsurance to 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 50% coinsurance for diabetic supplies. Prior authorization is required for these benefits, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 001 NC (HMO) covers diagnostic services with no coinsurance, offering no copay for lab services and copays ranging from $0 to $95 for diagnostic procedures. Covered radiological services feature a $0 copay for outpatient X-rays, diagnostic radiological copays starting at $0, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by DEVOTED CORE 001 NC (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CORE 001 NC (HMO) with no coinsurance, requiring prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 001 NC (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, prior hospital stays of less than three days are allowed, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other services under DEVOTED CORE 001 NC (HMO) are partially covered, featuring no copay and no coinsurance for over-the-counter (OTC) items and additional preventive services. Acupuncture, meal benefits, and certain other supplemental services are not covered under this plan.
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