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DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PLUS 013 IN (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 PLUS 013 IN (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Indiana. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PLUS 013 IN (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 PLUS 013 IN (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 PLUS 013 IN (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 PLUS 013 IN (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.40. 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 has a $820.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $13900.00 (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 $13900.00 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:
Sign up for DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, standard pharmacy and mail-order options require a copay starting at $18 and $19 respectively for a one-month supply. Notably, Tier 6 select care drugs are covered with no copay for one-month, two-month, and three-month supplies. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 31% coinsurance through standard pharmacies and mail order. These coinsurance rates apply to multi-month fills, except for Tier 5 specialty drugs which are limited to a one-month supply.
Additional Benefits
The DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) plan offers comprehensive medical coverage with many essential services featuring no copays, though coinsurance and flat copays apply to specific treatments. For medical care, primary care visits, preventive services, and home health care require no copay and no coinsurance, while specialist visits feature no copay but carry a 30% coinsurance. Inpatient hospital stays require a flat copay of $2,230 for acute care or $2,080 for psychiatric care per stay, with no coinsurance. Supplemental benefits include dental coverage with a generous $4,000 annual maximum and vision care with up to $300 yearly for eyewear, both offering options with no copay and no coinsurance. Prescription hearing aids are covered with copays ranging from $399 to $699, while routine hearing exams require no copay and a 50% coinsurance. Additionally, the plan features an over-the-counter allowance of up to $50 every three months with no copay or coinsurance.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and the plan does not cover upgrades, non-Medicare-covered stays, or additional psychiatric days.
Outpatient Services See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers outpatient services with no copay, though prior authorization is required. Outpatient hospital and ambulatory surgical center services require between no coinsurance and 50% coinsurance, while outpatient substance abuse and blood services incur a 30% coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers ambulance services with no copay, requiring prior authorization and a coinsurance of no coinsurance to 40% for ground transport and 40% for air transport. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and a 0% to 20% coinsurance up to $40 per visit, while worldwide emergency, urgent, and transportation services are covered up to a $25,000 maximum with no copay or coinsurance.
Primary Care See details
Primary care benefits under the DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) plan feature no copay and no coinsurance for primary care provider visits, while specialist visits, therapy, and mental health services have no copay and a 30% coinsurance. Some chiropractic services are covered, but routine and other chiropractic care are not covered.
Preventive Services See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. While various supplemental benefits like fitness programs and nutritional counseling are included, other services such as in-home safety assessments, personal emergency response systems, and therapeutic massages are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP), featuring routine hearing exams with no copay and a 50% coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $399 to $699, but OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP), featuring one routine eye exam per year with no copay and 0% to 50% coinsurance, though other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay, no coinsurance, and no deductible up to a combined maximum of $300 per year.
Dental Services See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) partially covers dental services with a $4,000 annual maximum benefit, offering no copay and no coinsurance for covered preventive and comprehensive services, while Medicare-covered dental services require no copay and a 30% coinsurance. Sub-services that are not covered under this plan include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other drugs, carry no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay (which counts toward the deductible) and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) with no copay and 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment and diabetic supplies, and no coinsurance to 20% coinsurance for prosthetics and medical supplies. This benefit is partially covered, as diabetic therapeutic shoes and inserts are not covered, and prior authorization is required.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required. Diagnostic procedures and tests carry no coinsurance, while there is a 50% coinsurance for lab services, a 20% coinsurance for therapeutic radiological services, and a 40% coinsurance for both diagnostic radiological and outpatient X-ray services.
Home Health Services See details
Home health services are covered by DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered in practice by the DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) plan, as all sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered and require a 30% coinsurance with no copay.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) covers skilled nursing facility (SNF) care with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) partially covers other services, offering no copay and no coinsurance for over-the-counter items (up to $50 every three months), non-Medicare covered diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and dual-eligible SNP services are not covered.
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