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DEVOTED CORE 012 PA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 012 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 012 PA (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 012 PA (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Central Pennsylvania. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CORE 012 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 012 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 012 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 $6700.00 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 012 PA (HMO) Medicare plan features an annual prescription drug deductible of $375. For lower-tier medications, members benefit from no copay on Tier 1 (Preferred Generic) and Tier 2 (Generic) drugs filled at standard pharmacies or via standard mail order for one-, two-, or three-month supplies. Higher-tier medications require coinsurance, with Tier 3 (Preferred Brand) drugs carrying a 19% coinsurance and Tier 4 (Non-Preferred) drugs carrying a 25% coinsurance for standard retail and mail-order fills. Specialty drugs in Tier 5 are subject to a 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CORE 012 PA (HMO) plan features robust medical coverage with no copay and no coinsurance for primary care visits, home health services, and preventive care. For inpatient hospital stays, members pay no coinsurance but will face a $240 daily copay for the first few days of their stay. Emergency room visits require a $130 copay with no coinsurance, which is waived if admitted, while specialist visits and outpatient diagnostic tests carry low copays ranging from no copay up to $95. This plan also includes valuable supplemental benefits, such as dental care up to a $3,500 annual limit with no copay for preventive services and 0% to 50% coinsurance for comprehensive care. Vision and hearing benefits offer routine exams with low copays, alongside a $350 annual eyewear allowance and prescription hearing aid copays between $399 and $699. Additionally, members receive a $75 quarterly allowance with no copay for over-the-counter items, while durable medical equipment generally requires a 20% to 25% coinsurance.
Inpatient Hospital See details
DEVOTED CORE 012 PA (HMO) covers inpatient hospital stays with no coinsurance, requiring a $240 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, with no copay for subsequent days. While unlimited additional acute days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 012 PA (HMO) covers outpatient services with no coinsurance, featuring a $0 to $340 copay for outpatient hospital services, a $240 copay per stay for observation services, and a $30 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, with prior authorization required for most of these outpatient services.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CORE 012 PA (HMO) with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED CORE 012 PA (HMO) covers ground ambulance services with a $0 to $315 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay, with prior authorization required for both. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services under the DEVOTED CORE 012 PA (HMO) plan are covered 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, while worldwide emergency services are covered up to a $25,000 maximum with copays up to $315 and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 012 PA (HMO) covers primary care physician services with no copay and no coinsurance, while chiropractic services are partially covered, excluding routine and other chiropractic care. Other covered services like specialist visits, physical therapy, and mental health sessions require copays ranging from $0 to $50 and no coinsurance, though podiatry services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED CORE 012 PA (HMO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered with no copay and no coinsurance, offering fitness programs and nutritional counseling, while sub-services such as in-home support, therapeutic massage, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED CORE 012 PA (HMO) partially covers hearing services, excluding OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids. Routine exams require a $30 copay and no coinsurance, while covered prescription hearing aids have no coinsurance and a copay between $399 and $699, with no deductible required.
Vision Services See details
DEVOTED CORE 012 PA (HMO) partially covers vision services, offering one routine eye exam per year with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $350 annual maximum benefit that applies to contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CORE 012 PA (HMO) dental services are partially covered up to a $3,500 annual limit, offering preventive care with no copay and no coinsurance, and Medicare-covered dental with a $30 copay and no coinsurance. While comprehensive services like endodontics and prosthodontics require no copay and 0% to 50% coinsurance, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 012 PA (HMO) covers Home Infusion bundled Services with no copay, although prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance up to 20%, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
DEVOTED CORE 012 PA (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
DEVOTED CORE 012 PA (HMO) partially covers medical equipment with no copays, requiring prior authorization for all services, though diabetic therapeutic shoes and inserts are not covered. Durable medical equipment requires a 20% to 25% coinsurance, while covered prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% or 25% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CORE 012 PA (HMO) with prior authorization, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests carry no coinsurance and a copay ranging from $0 to $95, while therapeutic radiology requires a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CORE 012 PA (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under DEVOTED CORE 012 PA (HMO) require prior authorization and have no coinsurance, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice and require copayments ranging from $25 to $30.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED CORE 012 PA (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. This benefit is partially covered because additional days beyond the 100 Medicare-covered days are not covered, and prior authorization is required.
Other Services See details
DEVOTED CORE 012 PA (HMO) partially covers other services, offering additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance, including a $75 allowance every three months for OTC items. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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