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DEVOTED CORE 001 VA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 001 VA (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 001 VA (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 001 VA (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Western Virginia Highlands. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CORE 001 VA (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 001 VA (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 001 VA (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 $330.00 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 $5900.00 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 001 VA (HMO) Medicare plan features an annual prescription drug deductible of $330. Beneficiaries will pay no copay for Tier 1 preferred generic and Tier 2 generic drugs filled at standard pharmacies or through standard mail order. This cost-free coverage applies to one-month, two-month, and three-month supplies of these generic medications. For brand-name and specialty prescriptions, costs are determined by coinsurance percentages at standard pharmacies and standard mail order. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for up to a three-month supply. Tier 5 specialty drugs are covered with a 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CORE 001 VA (HMO) plan offers comprehensive medical coverage featuring no copay for primary care physician visits and a $25 copay for specialists. For inpatient hospital stays, members pay a $325 daily copay for the first 6 days, followed by no copay for days 7 through 90. Emergency room visits carry a $130 copay, which is waived if you are admitted, while urgently needed care ranges from no copay to a $45 copay. In addition to medical care, the plan provides valuable dental, vision, and hearing benefits to lower your out-of-pocket costs. Preventive dental services have no copay and comprehensive dental care is covered up to a $3,000 annual maximum, while routine eye exams range from no copay to a $25 copay with a $300 yearly eyewear allowance. Prescription hearing aids require a copay between $399 and $699, and members also receive a $50 over-the-counter quarterly allowance with no copay.
Inpatient Hospital See details
DEVOTED CORE 001 VA (HMO) covers inpatient hospital services with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional inpatient psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 001 VA (HMO) covers outpatient services with no coinsurance, offering no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay ranging from no copay to $425, while outpatient substance abuse sessions have a $25 copay and observation services cost a $325 copay per stay.
Partial Hospitalization See details
DEVOTED CORE 001 VA (HMO) covers partial hospitalization services with an $80.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED CORE 001 VA (HMO), offering ground ambulance with a copay of $0 to $315 and no coinsurance, and air ambulance with a 20% coinsurance and no copay, both requiring prior authorization. While some transportation services are covered, trips to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 001 VA (HMO) covers emergency services with a $130 copay and no coinsurance (waived if admitted within 24 hours), and urgently needed services with no copay to a $45 copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 limit, requiring a $130 copay and no coinsurance for care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
Primary care services under DEVOTED CORE 001 VA (HMO) feature no copay and no coinsurance for primary care physician visits, and a $25 copay with no coinsurance for specialists. Therapy, mental health, and telehealth services require copays ranging from $0 to $50 with no coinsurance, while podiatry is not covered, and for chiropractic services, some services are covered but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
DEVOTED CORE 001 VA (HMO) offers partially covered preventive services with no copay and no coinsurance for covered services like annual physical exams, fitness benefits, and kidney disease education. While many wellness benefits are included, several sub-services are not covered, such as in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, and therapeutic massage.
Hearing Services See details
DEVOTED CORE 001 VA (HMO) offers partially covered hearing services, including one annual routine hearing exam for a $25 copay and no coinsurance, plus unlimited fitting evaluations. Up to two prescription hearing aids are covered per year with a copay ranging from $399.00 to $699.00 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services under the DEVOTED CORE 001 VA (HMO) plan are partially covered, offering one routine eye exam per year with a $0 to $25 copay, no deductible, and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no deductible, and no coinsurance up to a $300 annual maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED CORE 001 VA (HMO) offers partially covered dental services up to a $3,000 annual maximum, featuring no copay and no coinsurance for preventive care, and no copay with 0% to 50% coinsurance for restorative, endodontic, and prosthodontic services. Medicare-covered dental services require a $25 copay and no coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 001 VA (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy may apply. Covered Medicare Part B drugs, including chemotherapy and radiation, require 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 by DEVOTED CORE 001 VA (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED CORE 001 VA (HMO) with no copays, as diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment requires 20% to 30% coinsurance, prosthetics and medical supplies carry no coinsurance to 20% coinsurance, and diabetic supplies carry no coinsurance to 30% coinsurance.
Diagnostic and Radiological Services See details
DEVOTED CORE 001 VA (HMO) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic procedures with a copay ranging from $0 to $95. Covered radiological services require prior authorization and feature no copay for outpatient X-rays and diagnostic radiology, while therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
DEVOTED CORE 001 VA (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CORE 001 VA (HMO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and carry a $25 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 001 VA (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 copay for days 21 through 100, with additional days beyond the Medicare-covered limit not covered.
Other Services See details
DEVOTED CORE 001 VA (HMO) partially covers Other Services, offering additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance. The OTC benefit includes a $50 allowance every three months, but acupuncture and meal benefits are not covered.
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