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DEVOTED CORE 001 IL (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 001 IL (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 001 IL (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 001 IL (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Greater Chicago. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 001 IL (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 001 IL (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 001 IL (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 $395.00 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 $2700.00 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 001 IL (HMO) Medicare plan features an annual drug deductible of $395. For Tier 1 (Preferred Generic) and Tier 2 (Generic) medications, members enjoy no copay for 1-month, 2-month, and 3-month supplies filled through standard pharmacies or standard mail order. This makes essential generic prescriptions highly affordable and accessible under this plan. For higher-tier medications, costs are based on coinsurance rather than set copays at standard pharmacies and standard mail-order services. Tier 3 (Preferred Brand) drugs require a 23% coinsurance, Tier 4 (Non-Preferred Drug) medications have a 25% coinsurance, and Tier 5 (Specialty Tier) drugs require a 28% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED CORE 001 IL (HMO) plan provides robust coverage for essential medical services with predictable out-of-pocket costs. Patients enjoy no copay for primary care visits and a low $20 copay for specialists, while inpatient hospital stays require a $275 daily copay for the first seven days and no copay for days eight through 90. Emergency care is available with a $150 copay, and standard outpatient lab services and home health care are provided with no copay. In addition to core medical care, this plan features valuable supplemental benefits to lower your everyday healthcare expenses. Dental care includes preventive services with no copay up to a $3,000 annual maximum, and vision benefits offer routine exams and up to $300 annually for eyewear with no copay. Routine hearing exams carry a $20 copay, and members also receive a $30 allowance every three months for over-the-counter items with no copay.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED CORE 001 IL (HMO) with no coinsurance, requiring a $275 daily copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional days are covered for acute stays, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered under the DEVOTED CORE 001 IL (HMO) plan feature no coinsurance, with ambulatory surgical center and blood services available with no copay. Outpatient hospital services require a copay of $0 to $375, observation services have a $275 copay per stay, and outpatient substance abuse sessions carry a $20 copay, with prior authorization required for most services.
Partial Hospitalization See details
Partial hospitalization services are covered by DEVOTED CORE 001 IL (HMO) with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED CORE 001 IL (HMO) with prior authorization, requiring a copay of $0 to $350 and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED CORE 001 IL (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with no copay to a $45 copay and no coinsurance. Worldwide emergency services are also covered up to $25,000, featuring a $150 copay and no coinsurance for emergency or urgent care, and a $350 copay and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 001 IL (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, physical, occupational, and speech therapy, opioid treatment, and mental health services require a $20 copay and no coinsurance. Other healthcare professional services carry a $0 to $20 copay and no coinsurance, telehealth ranges from a $0 to $45 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED CORE 001 IL (HMO) offers partially covered preventive services with no copay and no coinsurance for covered benefits, including annual physical exams, fitness benefits, and kidney disease education. Sub-services that are not covered under this benefit include in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED CORE 001 IL (HMO) partially covers hearing services with no deductible, offering routine hearing exams for a $20 copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $399 to $699, but 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 CORE 001 IL (HMO), offering one routine eye exam per year with a $0 to $20 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, has no copay, no coinsurance, and no deductible, up to a $300 annual maximum benefit.
Dental Services See details
Dental Services are partially covered by DEVOTED CORE 001 IL (HMO), which offers Medicare-covered dental services for a $20 copay and no coinsurance, and preventive services with no copay and no coinsurance up to a $3,000 annual maximum. Comprehensive services require no copay and 0% to 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 001 IL (HMO) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Medicare Part B insulin drugs under this plan have a $35 copay and coinsurance ranging from no coinsurance to 20%, while Part B chemotherapy and other drugs have no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
DEVOTED CORE 001 IL (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED CORE 001 IL (HMO) with no copays, though prior authorization is required. Covered durable medical equipment carries a 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance, with diabetic therapeutic shoes and inserts excluded from coverage.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CORE 001 IL (HMO) and require prior authorization. Lab services and outpatient X-rays have no copay, diagnostic tests have a $0 to $95 copay with no coinsurance, 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 001 IL (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CORE 001 IL (HMO) with no coinsurance and require prior authorization. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $20 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 001 IL (HMO) 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, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED CORE 001 IL (HMO) partially covers other services, offering additional preventive services and over-the-counter (OTC) items up to $30 every three months with no copay and no coinsurance. However, acupuncture, meal benefits, and other miscellaneous services are not covered under this plan.
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