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DEVOTED CORE 023 PA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 023 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 023 PA (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 023 PA (HMO) is a HMO 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 CORE 023 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 023 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 023 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 $7500.00 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 023 PA (HMO) Medicare plan features an annual drug deductible of $375. For prescription drug coverage, Tier 1 preferred generic medications are available with no copay for one, two, or three-month supplies at standard pharmacies and through mail order. Tier 2 generic drugs are also highly affordable, starting at a $5 copay for a one-month supply and capping at $15 for a three-month supply. For higher-tier medications, members pay a percentage of the drug cost rather than a flat copayment. Tier 3 preferred brand drugs require 24% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance. Tier 5 specialty drugs require 28% coinsurance and are limited to a one-month supply.
Additional Benefits
The DEVOTED CORE 023 PA (HMO) plan offers robust coverage for essential medical needs, featuring no copay and no coinsurance for primary care visits and home health services. For inpatient hospital stays, members pay a daily copay of $295 for days one through seven and no copay for days eight through 90. Emergency room visits carry a $115 copay, which is waived upon admission, while outpatient hospital services range from no copay up to a $395 copay with no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,500 annual limit with no copay for most preventive and comprehensive services. Vision care features an annual routine exam and up to $200 yearly for eyewear with no copay, while routine hearing exams and prescription hearing aids are covered with low copays and no coinsurance. Additionally, members receive a $75 allowance every three months for over-the-counter items and enjoy a fitness benefit with no copay.
Inpatient Hospital See details
DEVOTED CORE 023 PA (HMO) partially covers inpatient hospital services with no coinsurance, charging a $295 daily copay for days 1 through 7 and no copay for days 8 through 90. Non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 023 PA (HMO) covers outpatient services with no coinsurance, though prior authorization is required. There is no copay for ambulatory surgical center and blood services, a $30 copay for outpatient substance abuse sessions, a $295 copay per stay for observation services, and a copay of $0 to $395 for outpatient hospital services.
Partial Hospitalization See details
DEVOTED CORE 023 PA (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED CORE 023 PA (HMO) covers ground ambulance services with a copay ranging from no copay to $315 and no coinsurance, while air ambulance services require a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 023 PA (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a copay ranging from no copay to $40 and no coinsurance. Worldwide emergency and urgent services are also covered up to a $25,000 lifetime maximum, featuring a $115 copay and no coinsurance for emergency or urgent care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 023 PA (HMO) covers primary care physician services with no copay and no coinsurance, while specialist, mental health, and therapy services require copayments ranging from $30.00 to $50.00 and no coinsurance. Chiropractic and podiatry services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered under the DEVOTED CORE 023 PA (HMO) plan with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and fitness benefits. Some sub-services are not covered, including in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, and therapeutic massage.
Hearing Services See details
Hearing Services are partially covered by DEVOTED CORE 023 PA (HMO), offering routine exams and fitting evaluations for a $30 copay and no coinsurance, with no deductible. Covered prescription hearing aids have no coinsurance and a copay ranging from $399 to $699, but OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED CORE 023 PA (HMO), 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 also covered with no copay, no coinsurance, and no deductible up to a $200 yearly limit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by DEVOTED CORE 023 PA (HMO) up to a $2,500 annual maximum, with a $30 copay and no coinsurance for Medicare-covered dental. Most covered preventive and comprehensive services feature no copay and no coinsurance, while restorative, endodontic, and prosthodontic services have no copay and 0% to 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 023 PA (HMO) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 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 CORE 023 PA (HMO) plan with no copay and a 20% coinsurance, subject to prior authorization.
Medical Equipment See details
DEVOTED CORE 023 PA (HMO) partially covers medical equipment with no copays, though prior authorization is required and diabetic therapeutic shoes and inserts are not covered. Durable medical equipment carries a 20% coinsurance, while diabetic supplies, prosthetic devices, and medical supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CORE 023 PA (HMO) with prior authorization required. Diagnostic procedures have no coinsurance and a copay ranging from no copay to $95, while lab services, outpatient X-rays, and diagnostic radiological services feature no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CORE 023 PA (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CORE 023 PA (HMO) with no coinsurance and require prior authorization. Although some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require copays ranging from $20 to $30.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED CORE 023 PA (HMO) with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, while additional days beyond the standard 100-day limit are not covered.
Other Services See details
Other Services are partially covered by DEVOTED CORE 023 PA (HMO), which offers over-the-counter (OTC) items up to $75 every three months and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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