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DEVOTED C-SNP PLUS 021 PA (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PLUS 021 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 PLUS 021 PA (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Philadelphia Area. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP PLUS 021 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 PLUS 021 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 PLUS 021 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 PLUS 021 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 $9250.00 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 PLUS 021 PA (HMO C-SNP) Medicare plan features an annual drug deductible of $615. For Tier 6 select care drugs, there is no copay for one-, two-, or three-month supplies filled through standard pharmacies or standard mail order. Tier 1 preferred generic drugs require an $18 copay for a one-month supply, while Tier 2 generic drugs have a $19 copay for a one-month supply. Higher-tier medications under this plan require coinsurance rather than flat copayments. Tier 3 preferred brand drugs and Tier 5 specialty drugs both carry a 25% coinsurance rate, though Tier 5 coverage is limited to a one-month supply. Tier 4 non-preferred drugs require a 31% coinsurance for one-, two-, and three-month supplies.
Additional Benefits
The DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) plan offers robust healthcare coverage featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For hospital care, inpatient acute stays require a $2,230 copay, while emergency room visits carry a $115 copay that is waived upon admission. Outpatient services and diagnostic tests generally feature no copays, though coinsurance ranging from 0% to 50% will apply to most services. Additional benefits include dental coverage with no copay up to a $2,000 annual limit, and vision benefits providing eyewear with no copay up to a $300 yearly maximum. Hearing aids are covered with copays ranging from $399 to $699, and members receive a $50 quarterly allowance for over-the-counter health items. Skilled nursing facility care is also available with no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) covers inpatient hospital services with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $2,230 copay per stay with unlimited additional days, while psychiatric stays require a $2,080 copay per stay, though upgrades, non-Medicare-covered stays, and psychiatric additional days are not covered.
Outpatient Services See details
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) covers outpatient services with no copays, though prior authorization is required and coinsurance applies to most services. Outpatient hospital and ambulatory surgical services feature 0% to 50% coinsurance, while observation services have a 50% coinsurance and outpatient substance abuse and blood services require a 30% coinsurance.
Partial Hospitalization See details
The DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) plan covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) with prior authorization, requiring no copay and a coinsurance of no coinsurance to 50% for ground transport and 50% coinsurance for air transport. Additionally, some transportation services are covered, though transportation to plan-approved and any health-related locations is not covered.
Emergency Services See details
DEVOTED C-SNP PLUS 021 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 have no copay and a 0% to 20% coinsurance (maximum $40 per visit), while worldwide emergency, urgent, and transportation services are covered with no copay or coinsurance up to a $25,000 maximum.
Primary Care See details
Primary care benefits under the DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) plan feature no copay and no coinsurance for primary care physician services, while chiropractic services are not covered. Most other specialty, therapy, mental health, and podiatry services are covered with no copay and a 30% coinsurance, typically requiring prior authorization.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) with no copay and no coinsurance for covered care, such as annual physicals, fitness benefits, and kidney education. Excluded from coverage are in-home safety assessments, PERS, medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, tobacco cessation, enhanced disease management, telemonitoring, counseling, and remote access technologies.
Hearing Services See details
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) covers hearing services, including one annual routine hearing exam with no copay and a 50% coinsurance, as well as unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $399 to $699 for up to two devices per year, but OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services under DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) are partially covered, offering one routine eye exam per year with no copay and 0% to 50% coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $300 annual maximum benefit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) covers Medicare dental services with no copay and 30% coinsurance, as well as other dental services up to a $2,000 annual maximum with no copay and no coinsurance. While many comprehensive and preventive services are covered, dental care is only partially covered, 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 PLUS 021 PA (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. 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 a coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) covers durable medical equipment, prosthetics, and medical supplies with no copay and coinsurance ranging from no coinsurance to 20%. Diabetic equipment is partially covered with no copay and 20% coinsurance for diabetic supplies, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required for all services. There is no coinsurance for diagnostic procedures and tests, but a 20% coinsurance applies to therapeutic radiology and a 50% coinsurance applies to lab services, diagnostic radiology, and outpatient X-rays.
Home Health Services See details
Home health services are covered by DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) with no copay and no coinsurance. Prior authorization is required to access this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) with no copay and prior authorization required, meaning some services are covered; however, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day inpatient hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP PLUS 021 PA (HMO C-SNP) with no copay and no coinsurance, including a $50 quarterly allowance for over-the-counter items, diabetic shoes, and additional preventive services. Acupuncture and meal benefits are not covered.
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