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Devoted CORE Tennessee (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CORE Tennessee (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CORE Tennessee (HMO) in 2025, please refer to our full plan details page.
Devoted CORE Tennessee (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 4 out of 5 stars in 2025.
It's important to know that Devoted CORE Tennessee (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 Tennessee (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 Tennessee (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 $590.00 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 Tennessee (HMO) plan has an "Enhanced Alternative" drug benefit type. The plan has a deductible of $590.00. In the initial coverage phase, after you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $10 copay for preferred generic drugs at a standard or mail order pharmacy. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Devoted CORE Tennessee (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and ambulance services. Emergency services have a copay, and there is also coverage for primary care, preventive services, hearing, vision, and dental care. This plan provides coverage for home health services, skilled nursing facilities, and medical equipment. It also covers home infusion, dialysis, and diagnostic services. Copays and coinsurance amounts vary depending on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For days 1-5, there is a $295 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $395, Observation Services with a $295 copay, and Ambulatory Surgical Center (ASC) Services with no copay. Outpatient Substance Abuse Services include Individual and Group Sessions, both with a copay of $30, and Outpatient Blood Services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CORE Tennessee (HMO) plan with a $60 copay, and requires prior authorization. There is no coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Devoted CORE Tennessee (HMO). Ground ambulance services have a copay of $0-$290, while air ambulance services have a 20% coinsurance; transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services are covered by the Devoted CORE Tennessee (HMO) plan, with a $125 copay, and no coinsurance. Urgently Needed Services are covered with a copay between $0 and $45, and no coinsurance. Worldwide Emergency Services are also covered, including Worldwide Emergency Coverage with a $125 copay and 20% coinsurance for Worldwide Emergency Transportation, and no coinsurance for Worldwide Urgent Coverage with a $125 copay.
Primary Care See details
The Devoted CORE Tennessee (HMO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $20 copay, and Routine Chiropractic Care is not covered. Occupational Therapy Services have a copay between $0 and $45, and Physician Specialist Services have a copay between $0 and $30. Individual and Group Sessions for Mental Health, Psychiatric, and Opioid Treatment Program Services have a $30 copay. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $50, and Additional Telehealth Benefits have a copay between $0 and $30.
Preventive Services See details
The Devoted CORE Tennessee (HMO) plan covers preventive services, including annual physical exams, health education, personal emergency response systems, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. In-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $30 copay, and for fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a copay between $399 and $699, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services with the Devoted CORE Tennessee (HMO) plan include eye exams with a $30 copay, routine eye exams once per year, and coverage for eyewear, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $1350 per year.
Dental Services See details
The Devoted CORE Tennessee (HMO) plan covers dental services, with a $30 copay for Medicare dental services. Other services such as Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics, removable, Prosthodontics, fixed, and Oral and Maxillofacial Surgery are covered. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted CORE Tennessee (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0% to 40% coinsurance, Prosthetic Devices with 0% to 20% coinsurance, and Medical Supplies with 20% coinsurance, but does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, or Diabetic Therapeutic Shoes/Inserts. Prior authorization is required for some services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $95, lab services with no copay, and outpatient X-ray services with no copay. Diagnostic radiological services have a copay up to $300, and therapeutic radiological services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the Devoted CORE Tennessee (HMO) plan, with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Devoted CORE Tennessee (HMO) plan, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for the covered services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CORE Tennessee (HMO) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Devoted CORE Tennessee (HMO) plan's "Other Services" benefit does not cover acupuncture, over-the-counter items, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. Other services are covered, including $0 preventive services.
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