A non-government entity
DEVOTED C-SNP CHOICE PREMIUM 017 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 PREMIUM 017 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 PREMIUM 017 IN (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Southeast and Louisville-Jeffersonville Indiana. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 017 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 PREMIUM 017 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 PREMIUM 017 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 PREMIUM 017 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 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 $7900.00 (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 $7900.00 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 PREMIUM 017 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 PREMIUM 017 IN (PPO C-SNP) Medicare plan features an annual prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 6 Select Care Drugs filled through standard pharmacies or standard mail order. For other generic options, a one-month supply costs an $18 copay for Tier 1 Preferred Generics and a $19 copay for Tier 2 Generics. Brand-name and specialty medications are covered under coinsurance rates rather than flat copays. Standard pharmacy and mail-order fills require 21% coinsurance for Tier 3 Preferred Brand drugs and 33% coinsurance for Tier 4 Non-Preferred drugs. Tier 5 Specialty Tier drugs are available with a 25% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, while specialist visits require a $45 copay. For hospital care, inpatient acute stays require a $420 copay for days 1 through 6 and no copay for days 7 through 90, with no coinsurance. Emergency room visits carry a $130 copay, which is waived if you are admitted, while urgently needed services range from no copay to a $45 copay. This plan also features strong supplemental benefits, including a $2,000 annual maximum for dental care with no copay for covered preventive services. Vision benefits include a $300 annual allowance for eyewear with no copay, and routine hearing exams require a $45 copay. Additionally, members benefit from a $50 quarterly over-the-counter item allowance and no copay for the first 20 days of skilled nursing facility stays.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) with no coinsurance, although upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute stays require a $420 copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays have a $420 copay for days 1 through 5 and no copay for days 6 through 90.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) outpatient services are covered with no coinsurance, featuring no copay for ambulatory surgical center and outpatient blood services. Outpatient hospital services require a copay of $0 to $520, observation services have a $420 copay per stay, and outpatient substance abuse sessions carry a $45 copay.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP), as transportation services to health-related locations are not covered. Covered ground ambulance services require a copay ranging from no copay to $315 plus coinsurance, while air ambulance services require a 20% coinsurance and a copay, with prior authorization required for all ambulance transfers.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 IN (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. Urgently needed services require no copay to a $45 copay with no coinsurance, and worldwide emergency services are covered up to a $25,000 limit with a $130 copay and no coinsurance for emergency or urgent care, and a $315 copay and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, mental health, psychiatric, and podiatry services require a $45 copay and no coinsurance. Physical, occupational, and speech therapy services have a copay of $45 to $50 with no coinsurance, telehealth services range from a $0 to $45 copay with no coinsurance, and chiropractic services are not covered.
Preventive Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) offers partially covered preventive services with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and health education. Sub-services that are not covered under this plan include in-home safety assessments, PERS, medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) hearing services include routine exams and fitting evaluations for a $45 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $399 to $699 for up to two devices per year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) offers partially covered eye exams with a $0 to $45 copay and no coinsurance, which covers one routine exam per year but excludes other eye exam services. Eyewear is covered with no copay or coinsurance up to a $300 annual maximum allowance for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) offers partially covered dental services with an annual maximum benefit of $2,000 for both in-network and out-of-network care. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered preventive and comprehensive dental services have no copay and no coinsurance, though other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 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 insulin, range from no coinsurance to 20% coinsurance, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered by the DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) covers medical equipment with no copays, though coinsurance and prior authorization may apply. Durable medical equipment carries a 20% to 50% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with no coinsurance to 50% coinsurance, excluding diabetic therapeutic shoes and inserts.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) with prior authorization required. Lab services have no copay and no coinsurance, diagnostic tests require a copay of $0 to $95 and no coinsurance, and radiological services carry varying copays and coinsurance, including no copay with applicable coinsurance for X-rays and a copay with a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) and require prior authorization, though only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) 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, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 Medicare-covered days are not covered.
Other Services See details
Other Services are partially covered under the DEVOTED C-SNP CHOICE PREMIUM 017 IN (PPO C-SNP) plan, which features no copay and no coinsurance for over-the-counter items (up to $50 every three months), non-Medicare diabetic shoes, and additional preventive services. Acupuncture and meal benefits are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved