A non-government entity
DEVOTED C-SNP PREMIUM 018 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 018 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 018 PA (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) is a HMO C-SNP 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 C-SNP PREMIUM 018 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 018 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 018 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 018 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:
Sign up for DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) plan features an annual drug deductible of $615. For Tier 6 select care drugs, you will pay no copay for one, two, or three-month supplies filled at standard pharmacies or through standard mail order. Under this plan, standard Tier 1 preferred generics cost an $18 copay for a one-month supply, while Tier 2 generics require a $20 copay. For higher-tier medications, costs are based on coinsurance rather than flat copays. Standard pharmacy and mail order fills require a 23% coinsurance for Tier 3 preferred brands and a 26% coinsurance for Tier 4 non-preferred drugs. Additionally, Tier 5 specialty tier drugs carry a 25% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $320 daily copay for the first few days and no copay for subsequent days, while emergency room visits carry a $115 copay that is waived if admitted. Outpatient services, diagnostic tests, and specialist visits are also covered with low to moderate copays and no coinsurance. This plan also includes valuable supplemental benefits to support your everyday health, including comprehensive dental coverage with no copay up to a $2,000 annual limit and a $300 yearly eyewear allowance with no copay. Routine hearing exams are available for a $35 copay, alongside coverage for up to two prescription hearing aids per year with copays between $399 and $699. Additionally, members benefit from a $50 quarterly over-the-counter item allowance and no copay for skilled nursing facility stays up to 20 days.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $320 daily copay for days 1 to 6 of acute stays (no copay for days 7 and beyond) and a $320 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered, and prior authorization is required.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services have a copay of $0 to $420, observation services carry a $320 copay per stay, and outpatient substance abuse sessions require a $35 copay.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers ground ambulance services with no copay to a $315 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services to plan-approved or any other health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, waived if admitted within 24 hours, and urgently needed services with no copay to a $40 copay and no coinsurance. Worldwide emergency and urgent services are covered up to $25,000 with a $115 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, but chiropractic services are not covered. Other covered benefits, including specialist visits, physical therapy, mental health, and telehealth services, require copays ranging from $0 to $50 and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and fitness benefits. Sub-services that are not covered under this plan include In-Home Safety Assessments, Personal Emergency Response Systems (PERS), post-discharge medication reconciliation, re-admission 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 technologies, and counseling.
Hearing Services See details
Hearing services are covered by DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP), which includes one routine hearing exam per year for a $35 copay and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are partially covered with a copay of $399 to $699 and no coinsurance for up to two aids per year, though OTC hearing aids and inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP), offering one annual routine eye exam with a $0 to $35 copay and no coinsurance, though other eye exam services are not covered. Eyewear is fully covered with no copay, no coinsurance, and no deductible, providing up to a $300 yearly maximum allowance for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered under DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $2,000 annual maximum. While many preventive and comprehensive services are included, specific sub-services such as other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require no coinsurance to 20% coinsurance, while covered Part B insulin requires a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers durable medical equipment, prosthetics, and diabetic supplies with no copay and coinsurance ranging from no coinsurance to 20%. This benefit is partially covered because diabetic therapeutic shoes and inserts are not covered, and prior authorization is required for covered equipment.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers diagnostic and radiological services, requiring prior authorization for all services. Lab services have no copay and no coinsurance, diagnostic procedures and tests range from a $0 to $95 copay with no coinsurance, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services under the DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) plan require prior authorization and have no copay or coinsurance. However, some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and requires prior authorization, without requiring a prior 3-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 018 PA (HMO C-SNP) offers partial coverage for other services, providing over-the-counter (OTC) items up to $50 every three months, diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved