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DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 011 CO (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 011 CO (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Southwest Colorado Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED C-SNP PREMIUM 011 CO (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 011 CO (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 011 CO (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 011 CO (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.20. 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 $7000.00 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 011 CO (HMO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generics, you will pay an $18 copay for a 1-month supply at standard pharmacies and standard mail order, while Tier 2 generics cost a $20 copay. Additionally, there is no copay for Tier 6 select care drugs, offering significant savings on essential medications. Higher-tier prescription drugs require coinsurance at standard pharmacies and standard mail order services. Tier 3 preferred brands have a 23% coinsurance, Tier 4 non-preferred drugs carry a 26% coinsurance, and Tier 5 specialty drugs require 25% coinsurance for a 1-month supply. Understanding these tier-based costs can help you plan your healthcare budget with this plan.
Additional Benefits
The DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, annual physicals, and home health care. For specialized medical needs, members pay a $35 to $50 copay for specialists, while inpatient hospital stays require a $365 daily copay for the first five to six days and no copay for the remaining days. Emergency care carries a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes key ancillary benefits, such as dental coverage up to a $2,000 annual limit with no copay for most preventive and comprehensive services. Vision care features a $300 annual eyewear allowance with no copay, and members receive a $50 over-the-counter item allowance every three months. Additionally, diagnostic labs and outpatient X-rays are covered with no copay, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $365 copay for days 1 to 6 of acute stays (no copay for days 7 to 90) and a $365 copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center services and outpatient blood services. Outpatient hospital services require a copay of $0 to $465, observation services carry a $365 copay per stay, and outpatient substance abuse sessions have a $45 copay.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) covers ambulance services with prior authorization, though transportation services are not covered. Ground ambulance services require no copay to a $270 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services have no copay to a $40 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with copays up to $270 and 20% coinsurance for transportation.
Primary Care See details
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist and physical therapy visits require copays ranging from $35 to $50 with no coinsurance. Chiropractic care is partially covered with a $15 copay and no coinsurance for routine visits, but other chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) with no copay and no coinsurance for annual physicals, kidney disease education, and various screenings. This benefit is partially covered, offering fitness programs and alternative therapies, but excluding services such as in-home support, caregiver support, and personal emergency response systems.
Hearing Services See details
Hearing Services are partially covered by DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP), featuring routine hearing exams with a $45 copay and no coinsurance, and prescription hearing aids with 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
Vision Services are partially covered by DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP), offering one routine annual eye exam with a $0 to $45 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, featuring a $300 annual maximum allowance for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) up to a $2,000 annual maximum, featuring a $45 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for most preventive and comprehensive care. Services such as implants, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, require a coinsurance ranging from no coinsurance to 20%, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered by DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) 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 PREMIUM 011 CO (HMO C-SNP) with no copay, requiring a 20% coinsurance for durable medical equipment and no coinsurance to 20% coinsurance for prosthetics, medical supplies, and diabetic supplies. Prior authorization is required for covered equipment, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) with prior authorization required. Diagnostic tests and procedures have no coinsurance and a copay of $0 to $95, therapeutic radiological services require a 20% coinsurance, and lab services, outpatient X-rays, and diagnostic radiological services are offered with no copay.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) provides no coinsurance for Cardiac Rehabilitation Services, but the benefit is not covered in practice as intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 011 CO (HMO C-SNP) partially covers other services with no copay and no coinsurance, including unlimited acupuncture, diabetic shoes, additional preventive services, and up to $50 every three months for over-the-counter items. Meal benefits and Other 3 services are not covered under this plan.
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