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DEVOTED C-SNP PREMIUM 019 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 019 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 019 PA (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) is a HMO C-SNP 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 C-SNP PREMIUM 019 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 019 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 019 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 019 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 019 PA (HMO C-SNP) plan features an annual prescription drug deductible of $615. For standard pharmacy and mail-order services, Tier 6 select care drugs are highly affordable with no copay required for up to a three-month supply. Tier 1 preferred generics have an $18 copay for a one-month supply, while Tier 2 generics cost a $20 copay. For brand-name and specialty medications, the plan transitions to a percentage-based coinsurance. Tier 3 preferred brands require a 23% coinsurance, and Tier 4 non-preferred drugs require a 26% coinsurance. Tier 5 specialty drugs are available only for a one-month supply and carry a 25% coinsurance.
Additional Benefits
The DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) plan offers robust health coverage with no copays and no coinsurance for primary care doctor visits, preventive services, and home health care. Dental and vision benefits are highly accessible, featuring no copays for preventive dental services up to a $2,000 annual limit, alongside no copay for eyewear up to a $300 yearly allowance. Routine hearing exams carry a $35 copay, while covered prescription hearing aids require copays between $399 and $699 with no coinsurance. For specialized medical needs, specialist visits require a $35 to $50 copay, and inpatient hospital stays require a $320 daily copay for the first several days. Skilled nursing care is available with no copay for the first 20 days, and diagnostic lab services also carry no copay. Additionally, the plan provides a fifty dollar over-the-counter item allowance every three months to help manage your health expenses.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) with no coinsurance, requiring a $320 daily copay for days 1 to 6 of acute stays (and no copay for days 7 to 90 with unlimited additional days) and a $320 daily copay for days 1 to 5 of psychiatric stays (and no copay for days 6 to 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $420 copay for outpatient hospital services and a $320 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are provided with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) covers ambulance services with prior authorization, requiring no copay to a $315 copay and coinsurance for ground transport, and a 20% coinsurance and a copay for air transport. For transportation benefits, some services are covered but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP PREMIUM 019 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, while worldwide emergency services are covered up to $25,000 with a $115 copay for emergency care and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
Primary care services are covered by DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) with no copay and no coinsurance for primary care physician visits. Most specialist, therapy, and mental health services require a copay of $35 to $50 and no coinsurance, although routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) with no copay and no coinsurance for all covered care. Sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems (PERS), 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 technologies, and counseling.
Hearing Services See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) covers hearing services, 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 for up to two aids per year, while OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) provides partially covered vision services with no deductibles, excluding other eye exam services while covering one annual routine exam with a $0 to $35 copay and no coinsurance. Eyewear is covered with no copay and no coinsurance, offering a $300 annual maximum for contacts, eyeglasses, and upgrades.
Dental Services See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) offers partially covered dental services up to a $2,000 annual limit, with no copay and no coinsurance for covered preventive and comprehensive services, and a $35 copay and no coinsurance for Medicare-covered dental. Excluded sub-services that are not covered include other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy and other drugs have no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) covers medical equipment with no copays, requiring a 20% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics, medical supplies, and diabetic supplies. Prior authorization is required for these services, and diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $95 copay for diagnostic tests. Radiological services require prior authorization, offering outpatient X-rays with no copay and therapeutic radiology with a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) with no copay and no coinsurance, but prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. You will pay no copay for days 1 through 20 and a $218 copay per day for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 019 PA (HMO C-SNP) partially covers other services, offering over-the-counter items up to fifty dollars every three months, diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this benefit.
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