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DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Northwestern/Southeastern North Carolina. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP PREMIUM 014 NC (HMO C-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 C-SNP PREMIUM 014 NC (HMO C-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 C-SNP PREMIUM 014 NC (HMO C-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 $6200.00 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 C-SNP PREMIUM 014 NC (HMO C-SNP) Medicare plan features an annual drug deductible of $615. For prescription drug coverage, you will pay no copay for Tier 6 select care drugs filled at standard pharmacies or through standard mail order. Tier 1 preferred generics cost an $18 copay for a one-month supply, while Tier 2 generics carry a $20 copay for a one-month supply. For brand-name and specialty medications, you will pay a coinsurance percentage instead of a flat copay at standard pharmacies and through standard mail order. Tier 3 preferred brands require 23% coinsurance, Tier 4 non-preferred drugs require 26% coinsurance, and Tier 5 specialty drugs require 25% coinsurance for a one-month supply. Two-month and three-month supply options are also available for tiers one through four to help manage your prescription costs.
Additional Benefits
The DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $430 daily copay for the first few days and no copay for the remaining days, while specialist visits require a $40 to $50 copay. Emergency room visits carry a $130 copay with no coinsurance, which is waived if you are admitted to the hospital within 24 hours. This plan also provides excellent supplemental benefits, including dental care with no copay up to a $2,000 yearly maximum and routine eyewear covered with no copay up to $300 annually. Routine hearing exams and prescription hearing aids are available with set copays and no coinsurance. Additionally, members can access over-the-counter items with no copay up to $50 every three months, while durable medical equipment requires a 20% to 50% coinsurance.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $430 daily copay for days 1 to 5 of acute stays (no copay for days 6 to 90) and a $430 daily copay for days 1 to 4 of psychiatric stays (no copay for days 5 to 90). The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) covers outpatient services with no coinsurance, though prior authorization is required for most care. Under this plan, there is no copay for ambulatory surgical center or blood services, a $40 copay for outpatient substance abuse sessions, a $430 copay per stay for observation services, and a copay of $0 to $530 for outpatient hospital services.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) because transportation services are not covered. Ground ambulance services require a copay of no copay to $325 with no coinsurance, while air ambulance services require a 20% coinsurance with no copay, both requiring prior authorization.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a copay ranging from no copay to $45 with no coinsurance, and worldwide emergency care is covered up to $25,000 with copays up to $325 and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, and podiatry services require copays ranging from $40 to $50 with no coinsurance. Telehealth benefits are also covered with a $0 to $45 copay and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) with no copay and no coinsurance for services such as annual physical exams, fitness benefits, and kidney disease education. However, certain sub-services are not covered, including in-home safety assessments, personal emergency response systems (PERS), therapeutic massage, and caregiver support.
Hearing Services See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) provides partially covered hearing services, featuring one annual routine hearing exam for a $40 copay and no coinsurance, alongside up to two annual prescription hearing aids with copays ranging from $399 to $699 and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) provides partially covered vision services with no deductible, though other eye exam services are not covered. Routine eye exams carry a $0 to $40 copay with no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $300 annual maximum.
Dental Services See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) offers partially covered dental services with a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services up to a $2,000 yearly maximum. While preventive and comprehensive care like cleanings, x-rays, and extractions are covered, other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and up to 20% coinsurance, while covered Part B insulin has a $35 copay and up to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) partially covers medical equipment with no copays, though prior authorization is required. Covered durable medical equipment (DME) requires 20% to 50% coinsurance, and prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) covers diagnostic services with no coinsurance, offering no copay for lab services and a $0 to $95 copay for diagnostic tests. Radiological services are also covered with prior authorization, featuring no copay for outpatient X-rays, a $0 minimum copay for diagnostic radiological services, and a copay with a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance and requires prior authorization, but does not require a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond day 100 are not covered.
Other Services See details
Other Services under DEVOTED C-SNP PREMIUM 014 NC (HMO C-SNP) are partially covered, excluding acupuncture and meal benefits. Covered benefits include over-the-counter (OTC) items up to $50 every three months, diabetic shoes, and additional preventive services, all offered with no copay and no coinsurance.
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