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DEVOTED CORE 010 PA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 010 PA (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 010 PA (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 010 PA (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Western Pennsylvania. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CORE 010 PA (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED CORE 010 PA (HMO).
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 CORE 010 PA (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $375.00 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 $5900.00 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 CORE 010 PA (HMO) Medicare plan features an annual drug deductible of $375. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs for up to a 3-month supply at standard pharmacies or through standard mail order. This structure helps keep everyday generic medications highly affordable for plan members. For brand-name and specialty medications, your cost sharing is based on a percentage of the drug cost. You will pay a 19% coinsurance for Tier 3 (Preferred Brand) drugs and a 25% coinsurance for Tier 4 (Non-Preferred) drugs for 1-month, 2-month, or 3-month fills. Specialty drugs in Tier 5 carry a 28% coinsurance for a 1-month supply at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED CORE 010 PA (HMO) plan provides comprehensive medical coverage featuring no copay for primary care doctor visits and a $30 copay for specialists. Inpatient hospital stays require a $240 daily copay for the first several days with no coinsurance, while emergency care has a $130 copay that is waived if you are admitted. Outpatient hospital services and diagnostic tests also offer affordable options, often requiring no copay and no coinsurance. This plan also includes valuable supplemental benefits, such as up to $4,000 in annual dental coverage with no copay for preventive care and a $350 annual allowance for eyewear. Additionally, members receive an over-the-counter allowance of $100 every three months and prescription hearing aid coverage with copays starting at $399. Home health care is available with no copay, while durable medical equipment and dialysis services require no copay but carry a 20% to 30% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED CORE 010 PA (HMO) with no coinsurance, requiring a $240 daily copay for days 1 through 6 of acute stays (no copay for days 7 through 90) and a $240 daily copay for days 1 through 5 of psychiatric stays (no copay for days 6 through 90). Prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 010 PA (HMO) covers outpatient hospital services with copays ranging from $0 to $340 and observation services with a $240 copay per stay, both featuring no coinsurance. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the DEVOTED CORE 010 PA (HMO) plan with a $60.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance services under DEVOTED CORE 010 PA (HMO) require prior authorization, offering ground ambulance coverage with a copay of $0 to $315 and coinsurance, and air ambulance coverage with 20% coinsurance and a copay. Routine transportation services are not covered.
Emergency Services See details
Emergency services are covered by DEVOTED CORE 010 PA (HMO) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $45 copay with no coinsurance, and worldwide emergency services are covered up to $25,000 with copays ranging from $130 to $315 and 20% coinsurance for emergency transportation.
Primary Care See details
Primary care services are covered by DEVOTED CORE 010 PA (HMO) with no copay and no coinsurance for primary care provider visits, and a $30 copay with no coinsurance for specialists, psychiatric, and mental health services. Physical and occupational therapies require a $30 to $50 copay with no coinsurance, while podiatry and routine chiropractic services are not covered.
Preventive Services See details
DEVOTED CORE 010 PA (HMO) preventive services are covered with no copay and no coinsurance for services like annual physical exams, kidney disease education, and diabetes training. However, the benefit is only partially covered, as sub-services such as personal emergency response systems (PERS), in-home support, and therapeutic massage are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED CORE 010 PA (HMO), which offers one routine hearing exam per year for a $30 copay and no coinsurance, plus covered fitting evaluations. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $399 to $699, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED CORE 010 PA (HMO) vision services are partially covered, featuring one routine eye exam per year with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is fully covered with no copay and no coinsurance, providing up to a $350 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 010 PA (HMO), offering up to $4,000 in annual coverage with no copay and no coinsurance for preventive care, periodontics, and oral surgery. Medicare-covered dental requires a $30 copay and no coinsurance, while other covered comprehensive services have no copay and 0% to 50% coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CORE 010 PA (HMO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by DEVOTED CORE 010 PA (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CORE 010 PA (HMO) covers medical equipment with no copays, requiring 20% to 30% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copay and up to 30% coinsurance for supplies, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 010 PA (HMO) covers diagnostic and radiological services with prior authorization, offering lab services, diagnostic radiological services, and outpatient X-rays with no copay and no coinsurance. Diagnostic procedures and tests have a copay of $0 to $95 with no coinsurance, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
DEVOTED CORE 010 PA (HMO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CORE 010 PA (HMO) technically covers cardiac rehabilitation services with no coinsurance and prior authorization, but in practice, these services are not covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CORE 010 PA (HMO) with no coinsurance and do not require a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare limit.
Other Services See details
DEVOTED CORE 010 PA (HMO) partially covers other services, offering no copay and no coinsurance for additional preventive services and Over-the-Counter (OTC) items, which includes a $100 allowance every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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