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DEVOTED C-SNP PLUS 015 NC (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PLUS 015 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 PLUS 015 NC (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) is a HMO C-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 C-SNP PLUS 015 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 PLUS 015 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 PLUS 015 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 PLUS 015 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 $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 C-SNP PLUS 015 NC (HMO C-SNP) Medicare plan features an annual drug deductible of $615. Under this plan, Tier 6 select care drugs are available with no copay for one-, two-, or three-month supplies at standard pharmacies and standard mail-order services. Tier 1 preferred generic drugs require an $18 copay per month, while Tier 2 generic drugs carry a $19 copay per month at standard pharmacies. For higher-tier medications, the plan transitions from flat copays to coinsurance percentages at standard pharmacies and standard mail-order services. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 31% coinsurance. These coinsurance rates apply to one-, two-, or three-month supplies, except for Tier 5 specialty drugs, which are only covered for a one-month supply.
Additional Benefits
The DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) plan offers robust medical coverage with no copay for primary care physician visits, home health services, and outpatient hospital care. For hospital stays, the plan features a $2,230 copay per acute inpatient admission and a $2,080 copay per psychiatric admission, with no coinsurance for either. Emergency care is accessible with a $115 copay that is waived if admitted, while other outpatient services require no copay and coinsurance up to 50%. Specialist consultations and Medicare-covered dental care feature no copay and a 30% coinsurance, while preventive services have no copay and no coinsurance. The plan also provides generous supplemental coverage, including up to $3,000 annually for dental benefits and a $300 annual eyewear allowance with no copays or coinsurance. Diagnostic hearing exams are available with no copay, and prescription hearing aids are covered with copays ranging from $399 to $699.
Inpatient Hospital See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) covers inpatient acute hospital stays with a $2,230 copay per admission and inpatient psychiatric stays with a $2,080 copay per admission, both featuring no coinsurance. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services covered by DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) feature no copays, though coinsurance and prior authorization requirements apply to most services. Outpatient hospital and ambulatory surgical center services carry no copay and coinsurance ranging from no coinsurance up to 50%, while outpatient substance abuse and blood services require no copay and 30% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) covers ambulance services with prior authorization, requiring no copay and a coinsurance of 0% to 50% for ground transport and 50% for air transport. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and a 0% to 20% coinsurance up to $40, while worldwide emergency, urgent, and transportation services are covered up to $25,000 with no copay and no coinsurance.
Primary Care See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while chiropractic services are not covered. Other covered services—including specialist visits, physical and occupational therapy, mental health, and podiatry—require no copay and a 30% coinsurance (0% to 30% coinsurance for telehealth).
Preventive Services See details
Preventive services are partially covered under DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and kidney disease education. Uncovered sub-services include in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) partially covers hearing services, offering diagnostic exams with no copay and annual routine exams with 50% coinsurance. Prescription hearing aids are covered with no coinsurance and a copay of $399 to $699 for up to two devices per year, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription aids are not covered.
Vision Services See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) offers partially covered vision services, featuring one annual routine eye exam with no copay and 0% to 50% coinsurance, though other eye exam services are not covered. Covered eyewear, including contacts, eyeglasses, and upgrades, has no copay, no coinsurance, and no deductible, up to a $300 annual maximum.
Dental Services See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) partially covers dental services, offering Medicare-covered dental care with no copay and 30% coinsurance, plus other dental benefits up to $3,000 annually with no copay and no coinsurance. However, other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and coinsurance ranging from no coinsurance to 20% which counts towards the plan-level deductible.
Dialysis Services See details
Dialysis services are covered by DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) covers durable medical equipment and prosthetics with no copay and coinsurance ranging from no coinsurance to 20%, subject to prior authorization. Diabetic equipment is partially covered with no copay and 20% coinsurance for supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) covers diagnostic and radiological services with no copays, subject to prior authorization. There is no coinsurance for diagnostic procedures and tests, but a 20% coinsurance applies to therapeutic radiology, and a 50% coinsurance applies to lab services, diagnostic radiology, and outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) with no copay and require prior authorization. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED C-SNP PLUS 015 NC (HMO C-SNP) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not needed, additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
Other Services are partially covered by DEVOTED C-SNP PLUS 015 NC (HMO C-SNP), featuring no copay and no coinsurance for over-the-counter (OTC) items up to $50 every three months, non-Medicare covered diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and Dual Eligible SNP services are not covered under this plan.
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