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DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 017 PA (HMO 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 PREMIUM 017 PA (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Eastern Pennsylvania. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP PREMIUM 017 PA (HMO 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 PREMIUM 017 PA (HMO 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 PREMIUM 017 PA (HMO 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 PREMIUM 017 PA (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.70. 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 $7000.00 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 C-SNP PREMIUM 017 PA (HMO C-SNP) Medicare plan features an annual drug deductible of $615. For prescription drugs, the plan offers no copay for Tier 6 select care drugs at standard pharmacies and through standard mail order. Tier 1 preferred generic drugs carry an $18 copay for a one-month supply, while Tier 2 generic drugs cost a $20 copay per month. For brand-name and specialty medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands require a 23% coinsurance, while Tier 4 non-preferred drugs have a 26% coinsurance. Tier 5 specialty drugs incur a 25% coinsurance for a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay for primary care visits, annual physicals, and home health services. For inpatient hospital stays, members pay a $320 daily copay for the first 5 to 6 days and no copay for subsequent days, with no coinsurance required. Specialist visits and outpatient mental health sessions are also available with a $35 copay and no coinsurance. This plan also includes valuable supplemental benefits, such as preventive and comprehensive dental care up to a $2,000 annual maximum with no copay. Vision care features an annual routine eye exam and up to $300 for eyewear with no copay, while routine hearing exams require a $35 copay. Additionally, members receive a $50 over-the-counter item allowance every three months and emergency care for a $115 copay, which is waived if admitted.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $320 daily copay for days 1 to 6 for acute stays and days 1 to 5 for psychiatric stays, with no copay for subsequent days. While unlimited additional acute days are covered, this benefit is partially covered since upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) outpatient services feature no coinsurance, with outpatient hospital copays ranging from $0 to $420 and observation services costing a $320 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services covered by DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) require prior authorization, featuring ground ambulance services with no copay to a $315 copay plus coinsurance, and air ambulance services with a 20% coinsurance plus a copay. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-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 range from no copay to a $40 copay with no coinsurance, and worldwide emergency services are covered up to $25,000 with a $115 copay and no coinsurance for medical care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
Primary care services under the DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) are covered with no copay and no coinsurance, while specialist, occupational therapy, and mental health visits require a $35 copay and no coinsurance. Physical and speech therapy carry a $35 to $50 copay and no coinsurance, and chiropractic care is only partially covered at a $15 copay and no coinsurance because routine chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and nutritional therapy. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing services are covered by DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP), featuring a $35 copay and no coinsurance for routine hearing exams. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699, though OTC hearing aids and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) vision services are partially covered, offering one routine eye exam per year with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear, including contacts, lenses, frames, and upgrades, is covered with no copay, no coinsurance, and no deductible up to a $300 annual maximum.
Dental Services See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) partially covers dental services up to a $2,000 annual maximum, with Medicare-covered dental services requiring a $35 copay and no coinsurance. Other covered preventive and comprehensive services have no copay and no coinsurance, though other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Part B insulin drugs carry a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-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 C-SNP PREMIUM 017 PA (HMO C-SNP) covers medical equipment with no copay, featuring a 20% coinsurance for durable medical equipment (DME) and ranging from no coinsurance to 20% coinsurance for prosthetics, medical supplies, and diabetic supplies. Prior authorization is required for these covered benefits, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) with prior authorization required. Lab services have no copay and no coinsurance, diagnostic tests have no coinsurance with a copay ranging from $0 to $95, and outpatient X-rays have no copay but require coinsurance. Diagnostic radiological services have a minimum $0 copay, while therapeutic radiological services require both a copay and a minimum 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) with no coinsurance, though prior authorization is required. Covered services include standard and intensive cardiac rehabilitation for a $30 copay, pulmonary rehabilitation for a $25 copay, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) for a $20 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 017 PA (HMO C-SNP) partially covers Other Services, offering Over-the-Counter (OTC) items up to $50 every three months, diabetic shoes not covered by Medicare, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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