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DEVOTED C-SNP PREMIUM 013 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 013 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 013 VA (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) is a HMO C-SNP 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 C-SNP PREMIUM 013 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 013 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 013 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 013 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 $6200.00 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 013 VA (HMO C-SNP) Medicare plan features an annual prescription drug deductible of $615. Under this plan, you will pay no copay for Tier 6 select care drugs filled through standard pharmacies or standard mail order. For Tier 1 preferred generics and Tier 2 generics, one-month standard fills cost an $18 copay and $20 copay, respectively. For higher-tier medications, the plan charges a percentage of the drug cost instead of a flat copayment. Tier 3 preferred brands require a 23% coinsurance, while Tier 4 non-preferred drugs carry a 26% coinsurance. Tier 5 specialty medications require a 25% coinsurance for a one-month supply through standard pharmacies or standard mail order.
Additional Benefits
The DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay for primary care visits and a $35 copay for specialist consultations. For hospital care, inpatient stays require a $375 daily copay for the first six days and no copay thereafter, while emergency room visits carry a $130 copay that is waived if you are admitted. Outpatient surgical services, home health visits, and diagnostic lab tests are also fully covered with no copay. Additional benefits include preventive and comprehensive dental services with no copay up to a $2,000 yearly limit, alongside a $300 annual allowance for eyewear with no copay. Hearing care is partially covered, offering routine exams for a $35 copay and up to two prescription hearing aids per year with copays between $399 and $699. Members also benefit from a $50 over-the-counter allowance every three months with no copay, though durable medical equipment requires a 20% to 50% coinsurance.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $375 daily copay for days 1 through 6 and no copay for days 7 through 90. Prior authorization is required, and coverage excludes upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) covers outpatient services with no coinsurance, offering no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $475, observation services cost a $375 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) covers partial hospitalization services 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 are covered by DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP), with ground ambulance services requiring a $0 to $315 copay and no coinsurance, and air ambulance services requiring a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and although some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
DEVOTED C-SNP PREMIUM 013 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 have a $0 to $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with copays up to $315 and up to 20% coinsurance.
Primary Care See details
Primary care benefits under DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) feature no copay and no coinsurance for primary care physician services, while specialist visits require a $35 copay and no coinsurance. Physical, occupational, and speech therapy services require a $35 to $50 copay and no coinsurance, whereas chiropractic care is only partially covered since routine and other chiropractic services are not covered. Other services, including mental health, podiatry, and telehealth, are covered with no coinsurance and copays ranging from $0 to $45.
Preventive Services See details
Preventive services are covered by DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) with no copay and no coinsurance, including annual physical exams, fitness benefits, and kidney disease education. This benefit is partially covered, as several sub-services such as in-home support, personal emergency response systems, and therapeutic massages are not covered.
Hearing Services See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) partially covers hearing services, offering routine exams for a $35 copay and no coinsurance, and up to two prescription hearing aids per year for a $399 to $699 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) vision services are partially covered, offering one routine eye exam per year with a $0 to $35 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, providing up to a $300 annual maximum for contacts, glasses, and upgrades.
Dental Services See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) partially covers dental services up to a $2,000 yearly maximum, offering covered preventive and comprehensive services with no copay and no coinsurance. Medicare-covered dental services require a $35 copay and no coinsurance, while implants, orthodontics, maxillofacial prosthetics, other diagnostic dental, and other preventive dental are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 013 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, offering diabetic supplies with no coinsurance to 50% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) with prior authorization. Outpatient diagnostic procedures and tests have a copay ranging from $0 to $95 with no coinsurance, while lab services and outpatient X-rays feature no copay. Therapeutic radiological services are covered with a 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) covers home health services with no copay and no coinsurance. Prior authorization is required to access these fully covered services.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, standard cardiac rehabilitation, intensive cardiac rehabilitation, and pulmonary rehabilitation services (each with a $35 copay), as well as supervised exercise therapy for peripheral artery disease (with a $25 copay), are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services under the DEVOTED C-SNP PREMIUM 013 VA (HMO C-SNP) plan are partially covered, offering no copay and no coinsurance for over-the-counter items up to $50 every three months, non-Medicare diabetic shoes, and additional preventive services. Acupuncture and meal benefits are not covered under this plan.
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