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DEVOTED CORE 011 VA (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 011 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 011 VA (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 011 VA (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Southwest Virginia. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED CORE 011 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 011 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 011 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 011 VA (HMO) Medicare Advantage plan features an annual prescription drug deductible of $330. For Tier 1 preferred generic and Tier 2 generic medications, members enjoy no copay for one, two, or three-month supplies filled at standard pharmacies or through standard mail order. This ensures that essential everyday medications remain highly affordable for plan members. For higher-tier medications, costs are structured as a percentage of the drug cost rather than a flat fee. Tier 3 preferred brand drugs require a 19% coinsurance, and Tier 4 non-preferred drugs carry a 25% coinsurance for standard pharmacy and mail order fills. Tier 5 specialty drugs require a 28% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED CORE 011 VA (HMO) plan offers robust medical coverage with no copay for primary care visits and a $30 copay for specialist consultations. If you require hospital services, inpatient stays feature a $325 daily copay for the first six days and no copay for days seven through ninety, while emergency room visits carry a $130 copay. Preventive care, home health services, and routine dental exams are also fully covered with no copay or coinsurance. This plan includes valuable extra benefits, such as a dental allowance of up to $3,500 and a $350 annual limit for eyewear with no copay. Additionally, members can access a $50 quarterly over-the-counter item benefit with no copay to help cover everyday health wellness needs. Hearing exams are available for a $30 copay, alongside partial coverage for prescription hearing aids with no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED CORE 011 VA (HMO) with no coinsurance, requiring a $325 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional days are covered for acute care, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CORE 011 VA (HMO) with no coinsurance, featuring outpatient hospital copays from $0 to $425 and a $325 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are available with no copay and no coinsurance, while individual and group outpatient substance abuse sessions carry a $30 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED CORE 011 VA (HMO) with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services under DEVOTED CORE 011 VA (HMO) include prior-authorized ground ambulance services with a copay of no copay to $315 and air ambulance services with a 20% coinsurance. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED CORE 011 VA (HMO) covers emergency services with a $130 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 $45 and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 maximum with a $130 copay and no coinsurance, while worldwide emergency transportation has a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CORE 011 VA (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine and other chiropractic services, while podiatry services are not covered. Other covered benefits, including mental health, telehealth, and physical therapy, feature copays ranging from $0 to $50 and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by DEVOTED CORE 011 VA (HMO) with no copay and no coinsurance for covered options such as annual physicals, fitness benefits, and kidney disease education. Some additional services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and therapeutic massage.
Hearing Services See details
DEVOTED CORE 011 VA (HMO) covers hearing services, including one annual routine exam for a $30 copay and no coinsurance, and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
DEVOTED CORE 011 VA (HMO) offers partially covered vision services, which include one routine eye exam per year with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, offering a $350 annual maximum limit for contacts, eyeglasses, and upgrades.
Dental Services See details
DEVOTED CORE 011 VA (HMO) provides partially covered dental services with an annual maximum benefit of $3,500, offering preventive and diagnostic care with no copay and no coinsurance. While Medicare-covered dental services require a $30 copay and no coinsurance, other comprehensive services have no copay and 0% to 50% coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 011 VA (HMO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED CORE 011 VA (HMO) with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED CORE 011 VA (HMO) partially covers medical equipment with no copays, although prior authorization is required and coinsurance rates apply. Durable medical equipment carries a 20% to 25% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 25% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 011 VA (HMO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and diagnostic tests with a $0 to $95 copay and no coinsurance. Outpatient X-rays have no copay but require coinsurance, while diagnostic radiological copays start at $0, and therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CORE 011 VA (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CORE 011 VA (HMO) covers cardiac rehabilitation services with no copay and no coinsurance, though only some services are covered in practice as standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CORE 011 VA (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 copay for days 21 through 100. Prior authorization is required, a prior 3-day hospital stay is not required, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED CORE 011 VA (HMO) partially covers other services, offering over-the-counter (OTC) items and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and certain other services are not covered, and the OTC benefit is limited to $50 every three months with no carryover.
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