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DEVOTED DUAL 009 NC (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL 009 NC (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 009 NC (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL 009 NC (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 5 out of 5 stars in 2026.
It's important to know that DEVOTED DUAL 009 NC (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 009 NC (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 009 NC (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 009 NC (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $36.20. 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 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 009 NC (HMO D-SNP) Medicare plan features an annual drug deductible of $615. For Tiers 1 through 5, which cover preferred generic, generic, preferred brand, non-preferred, and specialty drugs, you will pay a 25% coinsurance at standard pharmacies and standard mail order. This consistent cost-sharing makes it easy to calculate your out-of-pocket drug expenses. For Tier 6 select care drugs, the plan offers no copay at standard pharmacies and standard mail order. This combination of a set deductible, a standard 25% coinsurance, and no copay on select medications helps you manage your healthcare budget effectively.
Additional Benefits
The DEVOTED DUAL 009 NC (HMO D-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, while specialist visits require a $25 copay. Inpatient hospital stays feature a $395 daily copay for the first five days and no copay for days six through ninety, with no coinsurance required. Emergency services carry a $130 copay, which is waived if you are admitted, while skilled nursing facility care starts with no copay for the first twenty days. This plan also includes valuable supplemental benefits, such as dental coverage with no copay for most services up to a $2,000 yearly limit and a $400 annual allowance for eyewear with no copay. Routine hearing exams require a $25 copay, while prescription hearing aids are covered with copays ranging from $399 to $699. Additionally, members receive a $50 over-the-counter allowance every three months with no copay, and durable medical equipment is covered with no copay and coinsurance ranging from 20% to 30%.
Inpatient Hospital See details
DEVOTED DUAL 009 NC (HMO D-SNP) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $395 daily copay for days 1 through 5 and no copay 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
Outpatient services are covered by DEVOTED DUAL 009 NC (HMO D-SNP) with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay of $0 to $495, observation services require a $395 copay per stay, and outpatient substance abuse sessions have a $25 copay.
Partial Hospitalization See details
DEVOTED DUAL 009 NC (HMO D-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance services under DEVOTED DUAL 009 NC (HMO D-SNP) require prior authorization and feature a copay ranging from no copay to $315 for ground transport, alongside a 20% coinsurance for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED DUAL 009 NC (HMO D-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with no copay to a $45 copay and no coinsurance. Worldwide emergency services are covered up to a $25,000 maximum, featuring a $130 copay and no coinsurance for emergency or urgent care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
Primary care services through the DEVOTED DUAL 009 NC (HMO D-SNP) plan feature no copay and no coinsurance for primary care physician visits, while specialist visits require a $25 copay and no coinsurance. Other covered services, such as physical therapy, mental health, and podiatry, have copays ranging from $0 to $50 with no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED DUAL 009 NC (HMO D-SNP) with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and nutritional counseling. While many services are included, several sub-services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services covered by DEVOTED DUAL 009 NC (HMO D-SNP) include one routine hearing exam per year with a $25 copay, no coinsurance, and no deductible, as well as unlimited fitting evaluations. Up to two prescription hearing aids are partially covered per year with copays ranging from $399 to $699 and no coinsurance, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
DEVOTED DUAL 009 NC (HMO D-SNP) vision services are partially covered, offering one routine eye exam per year with a $0 to $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $400 annual limit for contact lenses, eyeglasses, and upgrades.
Dental Services See details
DEVOTED DUAL 009 NC (HMO D-SNP) offers partially covered dental services with a $25 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,000 yearly maximum. Non-covered services include other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
DEVOTED DUAL 009 NC (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, insulin, and other drugs, carry a coinsurance ranging from no coinsurance to 20%, with insulin also requiring a $35.00 copay.
Dialysis Services See details
DEVOTED DUAL 009 NC (HMO D-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED DUAL 009 NC (HMO D-SNP) covers medical equipment with no copays, though prior authorization is required. This benefit is partially covered because diabetic therapeutic shoes and inserts are not covered, with other services requiring coinsurance ranging from 20% to 30% for durable medical equipment, no coinsurance to 20% for prosthetics and medical supplies, and no coinsurance to 30% for diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED DUAL 009 NC (HMO D-SNP) with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic radiological services have a minimum $0 copay, diagnostic procedures have no coinsurance and a $0 to $95 copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by DEVOTED DUAL 009 NC (HMO D-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED DUAL 009 NC (HMO D-SNP) plan, as none of the sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are covered in practice. For these services, there is no coinsurance, but a $25 copay and prior authorization are required.
Skilled Nursing Facility (SNF) See details
DEVOTED DUAL 009 NC (HMO D-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other services are partially covered by the DEVOTED DUAL 009 NC (HMO D-SNP) plan, which provides additional preventive services and over-the-counter items up to $50 every three months with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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