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DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO 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 CHOICE PREMIUM 005 SC (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in South Carolina. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO 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 CHOICE PREMIUM 005 SC (PPO 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 CHOICE PREMIUM 005 SC (PPO 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 CHOICE PREMIUM 005 SC (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.70. 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 combined Maximum Out-Of-Pocket cost of $10100.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10100.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 prescription drug coverage for the DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) plan includes an annual drug deductible of $615. For Tier 6 select care drugs, members pay no copay for up to a 3-month supply at standard pharmacies or through standard mail order. Tier 1 preferred generics have an $18 copay for a 1-month supply, while Tier 2 generics require a $19 copay. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brands have a 21% coinsurance, and Tier 4 non-preferred drugs require a 33% coinsurance for standard pharmacy and mail order options. Tier 5 specialty drugs are covered with a 25% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits, home health services, and annual preventive physicals. For inpatient hospital stays, members pay a $475 daily copay for the first few days, while outpatient hospital services carry a copay ranging from no copay up to $575. Specialist visits, physical therapy, and mental health services are also highly accessible, requiring no copay or low copays up to $50. Additional benefits include a $2,000 annual limit for preventive and comprehensive dental care with no copay, as well as up to $300 yearly for eyewear. Emergency care is covered with a $130 copay, which is waived upon hospital admission, while urgent care visits range from no copay up to $45. Furthermore, members pay no copay for the first 20 days of a skilled nursing facility stay and receive a $50 over-the-counter allowance every three months.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) covers inpatient hospital services with no coinsurance, though upgrades and non-Medicare-covered stays are not covered. Acute care requires a $475 daily copay for days 1 to 5 and no copay for days 6 and beyond, while psychiatric stays require a $475 daily copay for days 1 to 4 and no copay for days 5 to 90.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) covers outpatient services with no coinsurance, offering ambulatory surgical center and blood services with no copays. Outpatient hospital services carry a copay of $0 to $575, observation services require a $475 copay per stay, and outpatient substance abuse sessions have a $45 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization is covered by the DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) plan with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) covers ground ambulance services with a copay ranging from no copay to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Transportation services, including trips to plan-approved or any health-related locations, are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) 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 no coinsurance and a copay ranging from no copay to $45. Worldwide emergency services are covered up to a $25,000 maximum, requiring a $130 copay and no coinsurance for emergency and urgent care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
Primary care benefits under DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) feature no copay and no coinsurance for primary care provider visits. Specialist visits, mental health, therapy, and podiatry services are covered with no coinsurance and copays ranging from $0 to $50, while chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) with no copay and no coinsurance, including annual physical exams, kidney disease education, and fitness benefits. However, the benefit is partially covered because services such as in-home safety assessments, personal emergency response systems, medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, and counseling are not covered.
Hearing Services See details
Hearing services are covered by DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP), featuring routine hearing exams for a $45 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $399 to $699 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP), featuring routine eye exams with a $0 to $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible up to a $300 annual combined maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) partially covers dental services, offering a $45 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for most preventive and comprehensive dental up to a $2,000 yearly maximum. Sub-services such as other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) with no copays, although diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment requires 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) covers diagnostic services with no coinsurance, offering lab services with no copay and diagnostic tests with a copay of $0 to $95. Covered radiological services require prior authorization and feature no copay for outpatient X-rays (coinsurance applies), diagnostic radiology with copays starting at $0, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) offers Cardiac Rehabilitation Services with no coinsurance and prior authorization required, but in practice, only some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 005 SC (PPO C-SNP), offering no copay and no coinsurance for Over-the-Counter (OTC) items up to $50 every three months, non-Medicare diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and dual-eligible SNP highly integrated services are not covered.
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