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DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO 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 CHOICE PREMIUM 006 KY (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Kentucky. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO 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 CHOICE PREMIUM 006 KY (PPO 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 CHOICE PREMIUM 006 KY (PPO 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 CHOICE PREMIUM 006 KY (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.40. 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 combined Maximum Out-Of-Pocket cost of $9950.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9950.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 CHOICE PREMIUM 006 KY (PPO C-SNP) plan features a yearly prescription drug deductible of $615. For standard pharmacy and standard mail order services, Tier 1 preferred generic drugs cost an $18 copay for a one-month supply, while Tier 2 generic drugs cost $19. Tier 6 select care drugs offer the greatest savings with no copay required for one-, two-, or three-month fills. For higher-tier medications, cost-sharing is based on coinsurance at standard pharmacies and mail order services. Tier 3 preferred brand drugs require a 21% coinsurance, and Tier 4 non-preferred drugs carry a 33% coinsurance. Tier 5 specialty drugs are available with a 25% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) offers comprehensive medical coverage with predictable costs, featuring no copay for primary care visits, annual physical exams, and home health services. For inpatient hospital stays, members pay no coinsurance and a $405 daily copay for the first several days, after which there is no copay. Specialist visits, mental health services, and physical therapy require copays ranging from $45 to $50 with no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,000 yearly maximum with no copay for routine cleanings and exams. Vision care features no copay for eyewear alongside a $300 annual allowance, while routine hearing evaluations have no copay and prescription hearing aids require copays between $399 and $699. Additionally, members benefit from no copay on home infusion services, a $50 quarterly allowance for over-the-counter items, and no copay for laboratory tests.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) with no coinsurance, requiring a $405 copay for days 1 through 7 of acute stays and days 1 through 5 of psychiatric stays, followed by no copay for later days. Unlimited additional acute care days are covered, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay ranging from $0 to $505, outpatient observation services have a $405 copay per stay, and outpatient substance abuse sessions require a $45 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) covers ambulance services with prior authorization, requiring a copay ranging from no copay to $315 along with coinsurance for ground transport, and a 20% coinsurance along with a copay for air transport. Transportation services are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO 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. Urgently needed services require no copay to a $45 copay with no coinsurance, while worldwide emergency services are covered up to a $25,000 limit with copays up to $315 and up to 20% coinsurance.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) offers primary care visits with no copay and no coinsurance, while specialist, mental health, and podiatry services require a $45 copay and no coinsurance. Physical, occupational, and speech therapies require a $45 to $50 copay and no coinsurance, and chiropractic services are partially covered with routine and other chiropractic care not covered.
Preventive Services See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) provides partially covered preventive services with no copay and no coinsurance for covered benefits, such as annual physical exams, kidney disease education, and fitness programs. Some additional preventive services are not covered, including personal emergency response systems, therapeutic massage, in-home support, and telemonitoring.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) covers hearing exams with a $45 copay and no coinsurance, which includes one routine exam per year and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two aids per year, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision services under DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) are partially covered, offering one annual routine eye exam with a $0 to $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $300 yearly allowance for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) partially covers dental services with a $2,000 yearly maximum that applies to both in-network and out-of-network services. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered services—such as exams, cleanings, and extractions—have 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 CHOICE PREMIUM 006 KY (PPO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, require no coinsurance to 20% coinsurance, while covered insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) covers medical equipment with no copays, though prior authorization is required and coinsurance applies to most items. Durable medical equipment requires 20% to 50% coinsurance, prosthetics and medical supplies carry no coinsurance to 20% coinsurance, and diabetic supplies carry no coinsurance to 50% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) covers diagnostic and radiological services, with prior authorization required. Diagnostic services feature no coinsurance, offering no copay for lab services and copays from $0 to $95 for procedures, while radiological services range from no copay for outpatient X-rays to a minimum 20% coinsurance and a copay for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) offers Cardiac Rehabilitation Services with no coinsurance and required prior authorization, though in practice only some services are covered. Specifically, cardiac rehabilitation ($40 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) 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, and additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
Other Services under the DEVOTED C-SNP CHOICE PREMIUM 006 KY (PPO C-SNP) are partially covered, offering no copay and no coinsurance for over-the-counter items up to $50 every three months, non-Medicare covered diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and highly integrated dual-eligible SNP services are not covered.
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