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DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 010 VA (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 PREMIUM 010 VA (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Greater Richmond Area. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP PREMIUM 010 VA (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 PREMIUM 010 VA (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 PREMIUM 010 VA (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 PREMIUM 010 VA (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.60. 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 $5700.00 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 PREMIUM 010 VA (HMO C-SNP) plan features an annual prescription drug deductible of $615. For standard pharmacy and mail order services, Tier 6 Select Care Drugs are available with no copay for all supply lengths. Tier 1 Preferred Generic drugs carry an $18 copay for a one-month supply, while Tier 2 Generic drugs require a $20 copay. For higher-tier medications, costs are based on coinsurance percentages rather than flat copays. Tier 3 Preferred Brand drugs require a 23% coinsurance, Tier 4 Non-Preferred drugs carry a 26% coinsurance, and Tier 5 Specialty Tier drugs have a 25% coinsurance for a one-month supply. Standard two-month and three-month supplies are also available for Tiers 1 through 4 to help you manage your prescription medication costs.
Additional Benefits
The DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) plan offers robust medical coverage featuring no copay and no coinsurance for primary care visits, preventive care, and home health services. For specialized care, members can expect predictable copays, such as $30 to $50 for specialist visits and set daily copays for inpatient hospital stays. Emergency room visits require a $130 copay, which is waived upon hospital admission, while outpatient hospital services feature no coinsurance and variable copays. Supplemental benefits include dental coverage with no copay for most services up to a $2,500 annual maximum, alongside a $300 annual allowance for eyewear with no copay. Routine hearing exams require a $30 copay, and prescription hearing aids are covered with fixed copays of $399 to $699. While medical equipment and dialysis services require no copays, they do carry coinsurance ranging from 20% to 50%.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) partially covers inpatient hospital services with no coinsurance, as upgrades and non-Medicare-covered stays are not covered. Covered acute stays require a $395 copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $395 copay for days 1 to 5 and no copay for days 6 to 90.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $495 copay for outpatient hospital services and a $395 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) with prior authorization, offering ground ambulance services with a copay ranging from no copay to $315 plus coinsurance, and air ambulance services with a 20% coinsurance and a copay. Transportation services to plan-approved or health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to a $25,000 limit with varying copays and a 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) offers primary care physician visits with no copay and no coinsurance, while specialist visits, mental health services, and physical therapies require copays ranging from $30 to $50 and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine chiropractic care is not covered.
Preventive Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) covers preventive services, annual physical exams, and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, including fitness, nutrition, and weight management programs, while services such as in-home support, personal emergency response systems, and therapeutic massage are not covered.
Hearing Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) provides partially covered hearing services, including routine hearing exams for a $30 copay and no coinsurance, with prior authorization required. Prescription hearing aids are covered with a copay between $399 and $699 and no coinsurance for up to two devices per year, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) offers partially covered vision services, featuring one routine eye exam per year with a copay of $0 to $30 and no coinsurance, while other eye exams are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay or coinsurance up to a $300 annual maximum.
Dental Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) dental services are partially covered, requiring a $30 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental services up to a $2,500 annual maximum. Specific sub-services that are not covered include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) plan with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, incur no coinsurance to 20% coinsurance, with insulin services specifically requiring a $35 copay.
Dialysis Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment carries a 20% to 50% coinsurance, while prosthetics and medical supplies range from no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with no coinsurance to 50% coinsurance for supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) plan, requiring prior authorization for all services. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $95, while lab services and outpatient X-rays feature no copay. Diagnostic radiological services start at no copay, whereas therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation (each with a $30 copay), and supervised exercise therapy for symptomatic peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering 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 standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 010 VA (HMO C-SNP) offers partially covered other services, which include over-the-counter (OTC) items up to $50 every three months, non-Medicare covered diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered.
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