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Devoted DUAL North Carolina (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted DUAL North Carolina (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted DUAL North Carolina (HMO D-SNP) in 2025, please refer to our full plan details page.
Devoted DUAL North Carolina (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in North Carolina. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Devoted DUAL North Carolina (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Devoted DUAL North Carolina (HMO D-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 DUAL North Carolina (HMO D-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 DUAL North Carolina (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.00. 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 $6750.00 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 DUAL North Carolina (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy, you will pay $46 per month for Part D. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, after which you enter the catastrophic coverage phase. During the catastrophic coverage phase, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Devoted DUAL North Carolina (HMO D-SNP) plan offers comprehensive coverage including inpatient and outpatient hospital services, with varying copays depending on the specific service. You'll have access to primary care, hearing, vision, and dental services, with copays for exams and some treatments. This plan also includes coverage for ambulance, emergency, and home health services. Additionally, you'll find benefits for medical equipment, diagnostic and radiological services, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a copay of $395 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $495, Observation Services have a $395 copay, and ASC services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $25.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted DUAL North Carolina (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $60.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted DUAL North Carolina (HMO D-SNP) plan. Ground ambulance services have a copay of $0-$290, while air ambulance services have a 20% coinsurance. 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 DUAL North Carolina (HMO D-SNP) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a copay between $0 and $45. Worldwide Emergency Transportation has a $290 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay.
Primary Care See details
The Devoted DUAL North Carolina (HMO D-SNP) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25-$45 copay, physician specialist services with a $25 copay, mental health specialty services with a $25 copay, podiatry services with a $25 copay, other health care professional services with a $0-$25 copay, psychiatric services with a $25 copay, physical therapy and speech-language pathology services with a $25-$50 copay, additional telehealth benefits with a $0-$25 copay, and opioid treatment program services with a $25 copay. Routine chiropractic care is not covered.
Preventive Services See details
The Devoted DUAL North Carolina (HMO D-SNP) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, Personal Emergency Response System (PERS), weight management programs, alternative therapies, nutritional/dietary benefits, Fitness Benefit, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. 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 with a $25 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $699, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $25 copay, and eyewear with a combined maximum benefit of $500 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 $25 copay, other dental services, and orthodontic services. Other services such as Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
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 and Other Medicare Part B Drugs, there is between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted DUAL North Carolina (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 25%, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies. Durable Medical Equipment for use outside the home, 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 and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted DUAL North Carolina (HMO D-SNP) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted DUAL North Carolina (HMO D-SNP) plan. Some services are covered, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted DUAL North Carolina (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services are not covered, 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. Some other services are covered, including $0 preventive services.
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