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Devoted DUAL PLUS Pennsylvania (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted DUAL PLUS Pennsylvania (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 Pennsylvania (HMO D-SNP) in 2025, please refer to our full plan details page.
Devoted DUAL PLUS Pennsylvania (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 2025.
It's important to know that Devoted DUAL PLUS Pennsylvania (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 Pennsylvania (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 Pennsylvania (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 Pennsylvania (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.10. 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 $590.00 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 $9350.00 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 Pennsylvania (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you'll pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. The provided information does not specify the cost sharing for each drug tier. If you qualify for the low-income subsidy (LIS), your monthly Part D premium will be $31.10. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Hospital stays have a $1950 copay per admission, while outpatient services and partial hospitalization have coinsurance requirements. Emergency and primary care services often have no copay, but some services, such as hearing and vision, do have coinsurance or copays. Preventive, dental, and home health services are covered with no copay, but some services require prior authorization. The plan also covers ambulance, home infusion, dialysis, medical equipment, and diagnostic services with copays or coinsurance. However, services such as cardiac rehabilitation and many "other services" are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered by the Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan. For both acute and psychiatric stays, there is a copay of $1950 per admission or stay. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a 35-40% coinsurance, while ambulatory surgical center services have a 35-40% coinsurance. Individual and group sessions for outpatient substance abuse have a 35% coinsurance. Outpatient blood services are covered with a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered under the Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan, but requires prior authorization. You will pay 35% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan. All ambulance services are covered, with a 0-35% coinsurance for ground ambulance services and a 35% coinsurance for air ambulance services, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan with a $110 copay, and Urgently Needed Services are covered with 35% coinsurance. Worldwide Emergency Services are also covered, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Opioid Treatment Program Services, and Additional Telehealth Benefits, with no copay or coinsurance for Occupational Therapy and Physical Therapy. Chiropractic Services and Mental Health/Psychiatric Specialty Services are partially covered, while Podiatry Services are not covered.
Preventive Services See details
Preventive Services for the Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan include coverage for Medicare-covered preventive services, annual physical exams, health education, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. In-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a coinsurance of up to 35%, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $0 and $299, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a 35% coinsurance, as well as coverage for eyewear, including contact lenses, eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $500 every year.
Dental Services See details
The Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan covers a range of dental services, including oral exams, dental x-rays, and other diagnostic services, with no cost to you. The plan also covers preventative services such as cleaning and fluoride treatment. Orthodontic services are covered under Diagnostic and Preventive Dental, with a maximum of $500 per year, and some services like Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance of 0-20%, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items. Diabetic Supplies have a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures, tests, lab services, and radiological services. There is no copay for these services, but coinsurance applies, with a maximum of 35% for diagnostic procedures, tests, and X-rays, and a maximum of 20% for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by the Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services are covered, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. This means that the plan does not offer coverage for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-64 the copay is $214, and for days 65-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered by the Devoted DUAL PLUS Pennsylvania (HMO D-SNP) plan, including acupuncture, over-the-counter items, meal benefits, dual eligible SNPs with highly integrated services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Other 2 benefits are covered, including $0 preventive services.
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