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DEVOTED DUAL PLUS 005 PA (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL PLUS 005 PA (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 PLUS 005 PA (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Pennsylvania. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED DUAL PLUS 005 PA (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 PLUS 005 PA (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 PLUS 005 PA (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 PLUS 005 PA (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $22.50. 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 Plus 005 PA (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generic, Tier 2 generic, Tier 3 preferred brand, and Tier 4 non-preferred drugs, you will pay a 25% coinsurance at standard pharmacies and standard mail order. This 25% coinsurance also applies to a 1-month supply of Tier 5 specialty drugs at standard pharmacies and standard mail order. For Tier 6 select care drugs, there is no copay for 1-month, 2-month, and 3-month supplies filled at standard pharmacies or standard mail order. This straightforward cost structure helps you easily project your out-of-pocket expenses for medications under this Medicare Advantage plan.
Additional Benefits
The DEVOTED DUAL PLUS 005 PA (HMO D-SNP) offers comprehensive healthcare coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a set copay per stay with no coinsurance, while outpatient services generally feature no copay but require coinsurance ranging from 0% to 50%. Emergency room visits carry a $115 copay, which is waived if you are admitted, and worldwide emergency coverage is included with no copays or coinsurance. Specialist visits, diagnostic imaging, and dialysis require no copay but carry coinsurance up to 30%. The plan features generous supplemental benefits, including up to $3,000 annually for preventive and comprehensive dental care with no copay or coinsurance, and up to $400 yearly for eyewear with no out-of-pocket costs. Additionally, members receive routine hearing exams, coverage for up to two hearing aids per year with low to no copays, and a $50 quarterly over-the-counter allowance.
Inpatient Hospital See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) covers outpatient services with no copays, though coinsurance and prior authorization are required for most services. Outpatient hospital and ambulatory surgical center services feature no copay and 0% to 50% coinsurance, while outpatient substance abuse and blood services require no copay and 30% coinsurance.
Partial Hospitalization See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required to access these covered services.
Ambulance and Transportation Services See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) covers ambulance services with no copayment, requiring a 50% coinsurance for air transport and ranging from no coinsurance to 50% coinsurance for ground transport, with prior authorization required. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED DUAL PLUS 005 PA (HMO D-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 require no copay and a 0% to 30% coinsurance (up to a $40 maximum per visit), while worldwide emergency, urgent, and transportation services are covered up to $25,000 with no copay or coinsurance.
Primary Care See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) covers primary care physician services with no copay and no coinsurance. Specialist visits, mental health, psychiatric, and therapy services are covered with no copay and 30% coinsurance (up to 30% for telehealth and other health professionals), while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED DUAL PLUS 005 PA (HMO D-SNP) with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and kidney disease education. However, sub-services such as personal emergency response systems, medical nutrition therapy, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, telemonitoring, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED DUAL PLUS 005 PA (HMO D-SNP), offering routine hearing exams with no copay and 50% coinsurance, and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $0 to $299, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) offers partially covered vision services, featuring one routine eye exam per year with no copay and a 0% to 50% coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $400 annual maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) offers partially covered dental services with up to $3,000 in annual coverage, featuring no copay and a 30% coinsurance for Medicare-covered dental care and no copay and no coinsurance for preventive and comprehensive benefits like cleanings, fillings, and extractions. However, other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED DUAL PLUS 005 PA (HMO D-SNP) with no copay and no coinsurance, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs have no copay and between no coinsurance and 20% coinsurance, while Part B insulin has a $35 copay (which counts toward the plan deductible) and between no coinsurance and 20% coinsurance.
Dialysis Services See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and a prior authorization requirement. Durable medical equipment and diabetic supplies require a 20% coinsurance, while prosthetic devices and medical supplies carry a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED DUAL PLUS 005 PA (HMO D-SNP) with prior authorization required and no copays. Diagnostic procedures and tests have no coinsurance, while lab services require a 50% coinsurance, and radiological services carry a 30% coinsurance for diagnostic and outpatient X-ray services and a 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered by DEVOTED DUAL PLUS 005 PA (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under DEVOTED DUAL PLUS 005 PA (HMO D-SNP) are not covered in practice. Specific services, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation, are not covered and require a 30% coinsurance and no copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED DUAL PLUS 005 PA (HMO D-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED DUAL PLUS 005 PA (HMO D-SNP) partially covers other services, offering additional preventive services and up to $50 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture, meal benefits, and highly integrated dual eligible SNP services are not covered.
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