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DEVOTED DUAL FULL 025 PA (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL FULL 025 PA (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED DUAL FULL 025 PA (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL FULL 025 PA (HMO D-SNP) is a HMO D-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Pennsylvania. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED DUAL FULL 025 PA (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED DUAL FULL 025 PA (HMO D-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 DUAL FULL 025 PA (HMO D-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 DUAL FULL 025 PA (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.70. 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 DUAL FULL 025 PA (HMO D-SNP) Medicare plan has an annual drug deductible of $615. For prescription drug Tiers 1 through 4, which cover preferred generic, generic, preferred brand, and non-preferred drugs, you will pay a 25% coinsurance at standard pharmacies and standard mail order. This 25% coinsurance applies to 1-month, 2-month, and 3-month supplies. For Tier 5 specialty drugs, there is a 25% coinsurance for a 1-month supply at standard pharmacies and standard mail order. Tier 6 select care drugs offer the most savings, featuring no copay for 1-month, 2-month, and 3-month supplies at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED DUAL FULL 025 PA (HMO D-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members will pay a copay of $2,230 per acute admission or $2,080 per psychiatric admission, with no coinsurance required. Outpatient services, diagnostic testing, and specialist visits generally feature no copay, though coinsurance rates ranging from 20% to 50% may apply. This plan also includes valuable supplemental benefits, such as up to $2,000 annually for routine dental care and a $400 annual allowance for eyewear, both with no copays or coinsurance. Additionally, members receive an over-the-counter allowance of $50 every three months and coverage for up to two prescription hearing aids per year with copays ranging from no copay to $299. Emergency and urgent care services are also covered, including worldwide emergency coverage up to $25,000 with no copay.
Inpatient Hospital See details
Inpatient hospital benefits are partially covered by DEVOTED DUAL FULL 025 PA (HMO D-SNP), requiring prior authorization and no coinsurance for all stays. Medicare-covered acute stays require a $2,230 copay per admission with unlimited additional days, while psychiatric stays require a $2,080 copay per admission; however, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED DUAL FULL 025 PA (HMO D-SNP) covers outpatient services with no copay, though prior authorization is required and coinsurance applies to most services. Patients will pay no coinsurance to 50% coinsurance for outpatient hospital and ambulatory surgical center services, and 30% coinsurance for outpatient substance abuse and blood services.
Partial Hospitalization See details
Partial hospitalization services are covered under the DEVOTED DUAL FULL 025 PA (HMO D-SNP) plan with no copay and a 30% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED DUAL FULL 025 PA (HMO D-SNP) covers ground ambulance services with no copay and no coinsurance to 50% coinsurance, and air ambulance services with no copay and 50% coinsurance, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED DUAL FULL 025 PA (HMO D-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 0% to 30% coinsurance (up to $40 per visit), while worldwide emergency services, urgent care, and emergency transportation are covered up to $25,000 with no copay and no coinsurance.
Primary Care See details
DEVOTED DUAL FULL 025 PA (HMO D-SNP) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, and mental health services require no copay and a 30% coinsurance. Chiropractic services are partially covered with no copay and 30% coinsurance, excluding routine chiropractic care, whereas podiatry services are not covered.
Preventive Services See details
DEVOTED DUAL FULL 025 PA (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and routine screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, though specific services such as in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, in-home support, and therapeutic massage are not covered.
Hearing Services See details
Hearing services covered by DEVOTED DUAL FULL 025 PA (HMO D-SNP) include one routine hearing exam per year with no copay and a 50% coinsurance, as well as unlimited fitting evaluations. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $0 to $299, though OTC models and inner-ear, outer-ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
DEVOTED DUAL FULL 025 PA (HMO D-SNP) covers vision services, offering one annual routine eye exam with no copay and 0% to 50% coinsurance, while other eye exam services are not covered. Eyewear is also covered up to a $400 annual maximum with no copay and no coinsurance.
Dental Services See details
Dental services are partially covered by DEVOTED DUAL FULL 025 PA (HMO D-SNP), featuring no copay and 30% coinsurance for Medicare-covered dental, alongside a $2,000 yearly maximum with no copay and no coinsurance for other dental services. Covered benefits include cleanings, exams, and fillings, while other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED DUAL FULL 025 PA (HMO D-SNP) with no copay, while associated Part B chemotherapy and other drugs require no copay and a 0% to 20% coinsurance. Part B insulin is covered with a $35 copay and 0% to 20% coinsurance, with prior authorization and step therapy applying to these services.
Dialysis Services See details
DEVOTED DUAL FULL 025 PA (HMO D-SNP) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by DEVOTED DUAL FULL 025 PA (HMO D-SNP) with no copay, though prior authorization is required. Durable medical equipment and diabetic equipment require a 20% coinsurance, while prosthetics and medical supplies carry a coinsurance ranging from no coinsurance to 20%.
Diagnostic and Radiological Services See details
DEVOTED DUAL FULL 025 PA (HMO D-SNP) covers diagnostic and radiological services with no copayments, though prior authorization is required. There is no coinsurance for diagnostic procedures and tests, but a 50% coinsurance applies to lab services, a 20% coinsurance applies to therapeutic radiological services, and a 30% coinsurance applies to diagnostic radiological and outpatient X-ray services.
Home Health Services See details
Home Health Services are covered under the DEVOTED DUAL FULL 025 PA (HMO D-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED DUAL FULL 025 PA (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, subject to prior authorization. However, 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) care is covered by DEVOTED DUAL FULL 025 PA (HMO D-SNP) with no coinsurance and requires prior authorization, without needing a prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
DEVOTED DUAL FULL 025 PA (HMO D-SNP) provides partial coverage for other services with no copay and no coinsurance, including additional preventive services and up to $50 every three months for over-the-counter (OTC) items. However, acupuncture and meal benefits are not covered under this plan.
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