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DEVOTED DUAL FULL 013 NC (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL FULL 013 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 FULL 013 NC (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL FULL 013 NC (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 FULL 013 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 FULL 013 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 FULL 013 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 FULL 013 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 $9250.00 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 FULL 013 NC (HMO D-SNP) Medicare plan features an annual prescription drug deductible of $615. For Tier 1 through Tier 4 drugs, which cover preferred generics, generics, preferred brands, and non-preferred drugs, standard pharmacies and standard mail order services charge a 25% coinsurance. Tier 5 specialty tier drugs also carry a 25% coinsurance for a 1-month supply at standard pharmacies and standard mail order. For individuals looking to minimize out-of-pocket costs, Tier 6 select care drugs feature no copay for 1-month, 2-month, and 3-month supplies at standard pharmacies and through standard mail order. This plan offers a clear cost-sharing structure to help members budget for their essential prescription medications.
Additional Benefits
The DEVOTED DUAL FULL 013 NC (HMO D-SNP) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and covered preventive care. For specialist visits and outpatient hospital services, you will pay no copay, though coinsurance ranges up to 50% depending on the treatment. Inpatient hospital stays require a $2,230 copay per acute stay with no coinsurance, while emergency room care carries a $115 copay that is waived if you are admitted within 24 hours. This plan also includes supplemental dental, vision, and hearing benefits to minimize your out-of-pocket expenses. Dental services feature no copay and no coinsurance for preventive and comprehensive care up to a $3,000 annual maximum. Additionally, routine eye exams have no copay, prescription hearing aids require a copay of $399 to $699, and members receive a $50 allowance every three months for over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care is covered under the DEVOTED DUAL FULL 013 NC (HMO D-SNP) plan with no coinsurance, requiring a $2,230 copay per acute stay and a $2,080 copay per psychiatric stay. While unlimited additional days for acute care are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED DUAL FULL 013 NC (HMO D-SNP) with no copays, though prior authorization is required for most treatments. Depending on the specific service, coinsurance ranges from 0% to 50% for outpatient hospital and ambulatory surgical center visits, and is 30% for outpatient substance abuse and blood services.
Partial Hospitalization See details
Partial hospitalization services are covered under the DEVOTED DUAL FULL 013 NC (HMO D-SNP) plan with no copay and a 30% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED DUAL FULL 013 NC (HMO D-SNP) with no copay, requiring prior authorization and a coinsurance of no coinsurance to 50% for ground ambulance and 50% for air ambulance. While transportation is listed as covered, some services are covered but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
DEVOTED DUAL FULL 013 NC (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and a 0% to 30% coinsurance, while worldwide emergency services are covered up to a $25,000 limit with no copay and no coinsurance.
Primary Care See details
DEVOTED DUAL FULL 013 NC (HMO D-SNP) covers primary care physician services with no copay and no coinsurance, and telehealth benefits with no copay and 0% to 30% coinsurance. Specialist visits, mental health, psychiatric, physical therapy, and occupational therapy services are covered with no copay and 30% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under the DEVOTED DUAL FULL 013 NC (HMO D-SNP) plan with no copay and no coinsurance for covered services like annual physical exams, fitness benefits, and nutritional counseling. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED DUAL FULL 013 NC (HMO D-SNP) provides partially covered hearing services, featuring hearing exams with no copay (and a 50% coinsurance for routine exams) and prescription hearing aids with no coinsurance and a copay of $399 to $699. Over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED DUAL FULL 013 NC (HMO D-SNP), offering one routine eye exam per year with no copay and 0% to 50% coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $400 per year for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED DUAL FULL 013 NC (HMO D-SNP), offering no copay and no coinsurance for preventive and comprehensive care up to a $3,000 annual maximum, though Medicare-covered dental services require a 30% coinsurance with no copay. Non-covered services include other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
DEVOTED DUAL FULL 013 NC (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance that counts toward the plan deductible.
Dialysis Services See details
Dialysis Services are covered by DEVOTED DUAL FULL 013 NC (HMO D-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED DUAL FULL 013 NC (HMO D-SNP) covers medical equipment with no copay, though prior authorization is required for these services. Durable medical equipment and diabetic equipment carry a 20% coinsurance, while prosthetic devices and medical supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
DEVOTED DUAL FULL 013 NC (HMO D-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required for these services. Covered diagnostic procedures have no coinsurance, while lab services require a 50% coinsurance, therapeutic radiological services require a 20% coinsurance, and diagnostic radiological and X-ray services carry a 30% coinsurance.
Home Health Services See details
DEVOTED DUAL FULL 013 NC (HMO D-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED DUAL FULL 013 NC (HMO D-SNP) with no copay, though prior authorization is required and some services are not covered in practice. Specifically, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
DEVOTED DUAL FULL 013 NC (HMO D-SNP) covers skilled nursing facility (SNF) care with no coinsurance and prior authorization, and does not require a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED DUAL FULL 013 NC (HMO D-SNP) partially covers other services, offering over-the-counter (OTC) items up to $50 every three months and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and highly integrated SNP services are not covered.
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