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DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 005 IL (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 005 IL (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP PREMIUM 005 IL (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 005 IL (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 005 IL (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 005 IL (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.20. 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 $3500.00 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 005 IL (HMO C-SNP) Medicare plan features an annual prescription drug deductible of $615. For Tier 6 select care drugs, you will benefit from no copay for one-, two-, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 1 preferred generic drugs carry an $18 copay for a one-month supply, while Tier 2 generic drugs require a $20 copay for a one-month supply. For higher-tier medications, costs are based on coinsurance rather than flat copayments. You will pay 23% coinsurance for Tier 3 preferred brand drugs and 26% coinsurance for Tier 4 non-preferred drugs. Tier 5 specialty tier drugs carry a 25% coinsurance and are limited to a one-month supply.
Additional Benefits
The DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) plan offers comprehensive medical coverage with no copay or coinsurance for primary care doctor visits, home health services, and preventive care. For specialist visits, physical therapy, and mental health services, members will pay a $35 copay with no coinsurance. Inpatient hospital stays require a $460 daily copay for the first 5 to 6 days followed by no copay, while emergency room visits carry a $150 copay that is waived if you are admitted. This plan also features valuable supplemental benefits, including dental coverage for preventive and comprehensive care up to a $2,000 annual maximum with no copay. Vision care is covered with no copay for routine exams and up to a $300 annual allowance for eyewear, while prescription hearing aids are available with copays ranging from $399 to $699. Additionally, members receive no copay on lab services, routine X-rays, and over-the-counter items up to $50 every three months.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $460 daily copay for days 1 to 6 for acute stays and days 1 to 5 for psychiatric stays, followed by no copay for remaining days. Prior authorization is required, and upgrades or non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $560 copay for hospital outpatient services, a $460 copay per stay for observation services, and a $35 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, and prior authorization is required for outpatient services.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) covers ambulance services with prior authorization, while transportation services are not covered. Medicare-covered ground ambulance services require coinsurance and a copay ranging from no copay to $315, while air ambulance services require a 20% coinsurance and a copay.
Emergency Services See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $45 copay with no coinsurance, while worldwide emergency services are covered up to $25,000 with a $150 copay (no coinsurance) for emergency or urgent care, and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialists, physical therapy, occupational therapy, and mental health services require a $35 copay and no coinsurance. Telehealth services carry a $0 to $45 copay and no coinsurance, and while some chiropractic services are covered, routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) with no copay and no coinsurance for covered services, including annual physicals, kidney disease education, fitness benefits, and nutritional therapy. Sub-services not covered under this plan include in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation sessions, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP), featuring routine exams for a $35 copay and no coinsurance, with no deductible. While up to two prescription hearing aids are covered yearly with copays ranging from $399 to $699 and no coinsurance, OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) provides partially covered vision services, which include one routine eye exam per year with a $0 to $35 copay and no coinsurance, though other eye exam services are not covered. Covered eyewear options—including contact lenses, eyeglasses, frames, and upgrades—have no deductible, no copay, and no coinsurance up to a $300 annual maximum.
Dental Services See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) partially covers dental services, offering preventive and comprehensive care up to a $2,000 annual maximum with no copay and no coinsurance, while Medicare-covered dental services require a $35 copay and no coinsurance. Sub-services that are not covered include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, insulin, and other drugs have no coinsurance up to 20% coinsurance, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) covers medical equipment with no copays and prior authorization required, featuring 20% to 50% coinsurance for durable medical equipment, no coinsurance to 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 50% coinsurance for diabetic supplies. This benefit is partially covered, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $95 copay for diagnostic tests, while radiological services require a 20% coinsurance for therapeutic services and no copay for outpatient X-rays and diagnostic radiology.
Home Health Services See details
Home Health Services are covered by DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) with no copay and no coinsurance. Prior authorization is required to receive these covered services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) with no coinsurance and require prior authorization, though only some services are covered. Specifically, standard cardiac rehabilitation, intensive cardiac rehabilitation, and pulmonary rehabilitation (each requiring a $35 copay), as well as supervised exercise therapy for peripheral artery disease (requiring a $30 copay), are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 005 IL (HMO C-SNP) partially covers other services, offering no copay and no coinsurance for over-the-counter items up to $50 every three months, diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and highly integrated dual-eligible SNP services are not covered under this plan.
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