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DEVOTED DUAL FULL 026 PA (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL FULL 026 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 026 PA (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL FULL 026 PA (HMO D-SNP) is a HMO D-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 DUAL FULL 026 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 026 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 026 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 026 PA (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $19.50. 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 026 PA (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. For Tiers 1 through 4, which cover preferred generics, generics, preferred brands, and non-preferred drugs, you will pay a 25% coinsurance at standard pharmacies and standard mail-order services. Tier 5 specialty drugs also require a 25% coinsurance for a one-month supply at standard pharmacies and standard mail order. For Tier 6 select care drugs, this plan offers no copay for one-, two-, or three-month supplies filled through standard pharmacies or standard mail-order services. Understanding these copay and coinsurance details can help you accurately estimate your yearly out-of-pocket medication costs with this HMO D-SNP plan.
Additional Benefits
The DEVOTED DUAL FULL 026 PA (HMO D-SNP) provides robust medical coverage, featuring no copays for primary care physician visits, outpatient hospital services, and home health care. While inpatient hospital stays require a copay of $2,230 for acute care and $2,080 for psychiatric care, other services like specialist visits, diagnostic procedures, and home infusions carry no copay with varying coinsurance. Emergency care is covered with a $115 copay, which is waived upon admission, while urgent care services require no copay. For dental, vision, and hearing needs, the plan offers up to $2,000 annually for dental care with no copay and a $400 annual allowance for eyewear. Members also receive no-copay routine hearing exams and a $50 allowance every three months for over-the-counter items. Essential medical equipment, diabetic supplies, and prosthetics are also covered with no copay, although standard coinsurance up to 20% applies.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED DUAL FULL 026 PA (HMO D-SNP), requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care, both with no coinsurance. Prior authorization is required, and while unlimited additional days are covered for acute stays, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under DEVOTED DUAL FULL 026 PA (HMO D-SNP) are covered with no copays, though prior authorization is required. Outpatient hospital and ambulatory surgical center services require no coinsurance to 50% coinsurance, while outpatient substance abuse and blood services have a 30% coinsurance.
Partial Hospitalization See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) covers partial hospitalization services with no copay and a 30% coinsurance. Prior authorization is required before you can receive this benefit.
Ambulance and Transportation Services See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) covers ambulance services with no copay, requiring a 0% to 50% coinsurance for ground services and a 50% coinsurance for air services, both of which require prior authorization. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) emergency services are covered with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay and 0% to 30% coinsurance (up to $40 per visit), while worldwide emergency services are covered up to $25,000 with no copay and no coinsurance.
Primary Care See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) covers primary care physician services with no copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, mental health, psychiatric, and opioid treatment services feature no copay and a 30% coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED DUAL FULL 026 PA (HMO D-SNP) with no copay and no coinsurance for annual physicals, kidney disease education, and select other services. However, additional preventive benefits are only partially covered, excluding in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) covers hearing exams with no copay, a 50% coinsurance for routine annual exams, and required prior authorization. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $0 to $299 for up to two aids per year, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) offers partially covered vision services, featuring one annual routine eye exam with no copay and 0% to 50% coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $400 annual maximum for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED DUAL FULL 026 PA (HMO D-SNP), offering up to $2,000 annually for preventive and comprehensive care with no copay and no coinsurance, while Medicare-covered dental requires no copay and a 30% coinsurance. Other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy may be required. Covered Medicare Part B drugs, including chemotherapy and other infusion drugs, carry a coinsurance ranging from 0% to 20%, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED DUAL FULL 026 PA (HMO D-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay and prior authorization required. A 20% coinsurance applies to DME and diabetic equipment, while prosthetics and medical supplies range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the DEVOTED DUAL FULL 026 PA (HMO D-SNP) plan with prior authorization required and no copays. Diagnostic procedures and tests carry no coinsurance, while lab services have a 50% coinsurance, therapeutic radiological services have a 20% coinsurance, and both diagnostic radiological and outpatient X-ray services require a 30% coinsurance.
Home Health Services See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) covers some Cardiac Rehabilitation Services with no copay and required prior authorization. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED DUAL FULL 026 PA (HMO D-SNP) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED DUAL FULL 026 PA (HMO D-SNP) partially covers other services, offering covered benefits with no copay and no coinsurance. Covered services include additional preventive services and Over-the-Counter (OTC) items up to a $50 limit every three months, while acupuncture and meal benefits are not covered.
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