A non-government entity
DEVOTED C-SNP PREMIUM 017 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 017 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 017 NC (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 017 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 Triad. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED C-SNP PREMIUM 017 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 017 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 017 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 017 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 $4800.00 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:
Sign up for DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The prescription drug coverage for the DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) plan features an annual drug deductible of $615. Standard pharmacies and standard mail order services offer Tier 1 preferred generic drugs for an $18 copay and Tier 2 generic drugs for a $20 copay for a 1-month supply. Additionally, Tier 6 select care drugs are highly affordable, requiring no copay for 1-month, 2-month, or 3-month supplies. For higher-tier medications, costs are based on coinsurance rather than flat copayments. You will pay 23% coinsurance for Tier 3 preferred brand drugs and 26% coinsurance for Tier 4 non-preferred drugs through standard pharmacies and standard mail order. Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, select telehealth services, and standard preventive care. For inpatient hospital stays, members pay a daily copay of $405 for the first several days and no copay for subsequent days, while emergency room visits require a $130 copay that is waived upon admission. Outpatient services feature copays ranging from no copay up to $505, with no coinsurance required for most outpatient hospital care. Supplemental benefits include dental coverage of up to $2,000 annually with no copay for preventive and comprehensive care, alongside a $300 annual allowance for eyewear with no copay. Routine hearing exams carry a $30 copay, and prescription hearing aids are covered for up to two devices per year with copays between $399 and $699. Additionally, members receive a $50 quarterly allowance with no copay for over-the-counter items, though cardiac rehabilitation and routine transportation services are not covered.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute care, you pay a $405 daily copay for days 1 through 6 and no copay for days 7 and beyond, while psychiatric care requires a $405 daily copay for days 1 through 5 and no copay for days 6 through 90. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services have a copay of $0 to $505, observation services require a $405 copay per stay, and outpatient substance abuse sessions carry a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) covers ambulance services with prior authorization, requiring no copay to a $325 copay plus coinsurance for ground ambulance, and a 20% coinsurance plus a copay for air ambulance. While some transportation services are technically covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
DEVOTED C-SNP PREMIUM 017 NC (HMO C-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 urgent care with no copay to a $45 copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 lifetime maximum with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $325 copay and 20% coinsurance.
Primary Care See details
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) provides primary care physician services and select telehealth benefits with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require copayments ranging from $30 to $50 with no coinsurance. Although chiropractic services are listed as covered, routine and other chiropractic services are not covered in practice.
Preventive Services See details
Preventive services are covered by DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) with no copay and no coinsurance, including annual physical exams and kidney disease education. Additional preventive benefits are partially covered, offering fitness and nutrition programs, but excluding services such as in-home safety assessments, personal emergency response systems, and therapeutic massage.
Hearing Services See details
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) provides partially covered hearing services, which include one routine hearing exam per year for a $30 copay and no coinsurance. Prescription hearing aids are covered for up to two devices per year with a copay ranging from $399 to $699 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) vision services are partially covered, offering one routine eye exam per year with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered and prior authorization is required. Eyewear is covered with no copay and no coinsurance, providing up to a $300 annual maximum allowance for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services under the DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) plan are partially covered, offering up to $2,000 annually with no copay and no coinsurance for preventive and comprehensive care, while Medicare-covered dental services require a $30 copay and no coinsurance. Services that are not covered under this plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) plan with no copay and require prior authorization. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required before you can receive these services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) with no copays, though prior authorization is required. Durable medical equipment carries a 20% to 50% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 50% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) with prior authorization required. Diagnostic procedures have no coinsurance and a copay ranging from $0 to $95, lab services and outpatient X-rays have no copay, and therapeutic radiology requires a copay and a minimum 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP PREMIUM 017 NC (HMO C-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 not covered under the DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) plan, as individual sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior 3-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP PREMIUM 017 NC (HMO C-SNP), which features no copay and no coinsurance for over-the-counter (OTC) items up to $50 every three months, diabetic shoes not covered by Medicare, and additional preventive services. Acupuncture and meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved