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DEVOTED CORE 001 TN (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 001 TN (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 TN (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 001 TN (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Knoxville. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 001 TN (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 TN (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 TN (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 $375.00 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 $4300.00 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 TN (HMO) prescription drug plan features an annual drug deductible of $375. For tier 1 preferred generic drugs, you will pay no copay for one-month, two-month, or three-month supplies filled at standard pharmacies or through standard mail order. Tier 2 generic drugs are available with a low $5.00 copay for a one-month supply, with three-month supplies costing $15.00 at standard pharmacies or $12.50 via standard mail order. Higher-tier medications under this plan require coinsurance instead of flat copays. Tier 3 preferred brand drugs carry a 24% coinsurance, and Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail order fills. Specialty drugs in Tier 5 are covered with a 28% coinsurance for a one-month supply at standard pharmacies and standard mail order.
Additional Benefits
The DEVOTED CORE 001 TN (HMO) plan offers comprehensive medical coverage, including primary care visits with no copay and specialist visits for a $30 copay, both with no coinsurance. Inpatient hospital stays require a $295 daily copay for days 1 through 5 and no copay for days 6 through 90, while outpatient hospital services range from no copay up to a $395 copay. Emergency room visits feature a $130 copay, which is waived if you are admitted to the hospital within 24 hours. For extra wellness needs, the plan provides up to a $3,500 annual dental maximum with no copay for preventive services and up to a $350 annual allowance for eyewear. Members also receive a $100 over-the-counter allowance every three months, routine hearing exams for a $30 copay, and home health services with no copay. Skilled nursing facility stays are also covered with no copay for the first 20 days.
Inpatient Hospital See details
DEVOTED CORE 001 TN (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $295 per day for days 1 through 5, and no copay for days 6 through 90. These benefits are partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 001 TN (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services have a $0 to $395 copay, observation services require a $295 copay per stay, and outpatient substance abuse sessions require a $30 copay, all with no coinsurance.
Partial Hospitalization See details
DEVOTED CORE 001 TN (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
DEVOTED CORE 001 TN (HMO) covers ground ambulance services with a copay ranging from no copay to $315 plus coinsurance, and air ambulance services with a 20% coinsurance plus a copay, with prior authorization required for all ambulance transfers. Transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 001 TN (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted within 24 hours, and urgently needed services with no copay to a $45 copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 maximum with a $130 copay and no coinsurance, while worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED CORE 001 TN (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $30 copay and no coinsurance. Physical, occupational, and speech therapy services require a $30 to $50 copay with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services under DEVOTED CORE 001 TN (HMO) are partially covered with no copay and no coinsurance, providing coverage for annual physicals, kidney disease education, and fitness benefits. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, therapeutic massages, adult day health, home-based palliative care, and in-home support services.
Hearing Services See details
DEVOTED CORE 001 TN (HMO) provides partially covered hearing services, featuring an annual routine hearing exam for a $30 copay and no coinsurance, alongside covered fitting evaluations. Up to two prescription hearing aids per year are covered with no coinsurance and copayments ranging from $399 to $699, though over-the-counter hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
DEVOTED CORE 001 TN (HMO) partially covers vision services, featuring one routine eye exam per year with a $0 to $30 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $350 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED CORE 001 TN (HMO) offers partially covered dental services up to a $3,500 annual maximum, featuring preventive care and select comprehensive services for no copay and no coinsurance. Other comprehensive services require no copay and 0% to 50% coinsurance, while Medicare-covered dental has a $30 copay and no coinsurance; however, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 001 TN (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CORE 001 TN (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
DEVOTED CORE 001 TN (HMO) partially covers medical equipment with no copay, though prior authorization is required and diabetic therapeutic shoes or inserts are not covered. Covered durable medical equipment requires a 20% to 50% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the DEVOTED CORE 001 TN (HMO) plan, with prior authorization required for services. Diagnostic procedures and tests have no coinsurance and a copay ranging from $0 to $95, while lab services and outpatient X-rays are available with no copay. Diagnostic radiological services start at a $0 copay, and therapeutic radiological services require a minimum 20% coinsurance plus applicable copays.
Home Health Services See details
DEVOTED CORE 001 TN (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are partially covered by DEVOTED CORE 001 TN (HMO) with no coinsurance, though prior authorization is required. Some services are covered, but standard cardiac, intensive cardiac, and pulmonary rehabilitation services (each with a $30 copay) as well as SET for PAD services (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 001 TN (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Other Services are partially covered by DEVOTED CORE 001 TN (HMO), offering Over-the-Counter (OTC) items up to $100 every three months and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
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