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Devoted BE WELL PLUS Tennessee (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted BE WELL PLUS Tennessee (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 BE WELL PLUS Tennessee (HMO C-SNP) in 2025, please refer to our full plan details page.
Devoted BE WELL PLUS Tennessee (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Memphis. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Devoted BE WELL PLUS Tennessee (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 BE WELL PLUS Tennessee (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 BE WELL PLUS Tennessee (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 BE WELL PLUS Tennessee (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.90. 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 $6200.00 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 BE WELL PLUS Tennessee (HMO C-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on the tier and pharmacy you use until your total drug costs reach $2,000. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), your monthly premium for Part D drugs is $24.90.
Additional Benefits
The Devoted BE WELL PLUS Tennessee (HMO C-SNP) plan offers a range of benefits. This plan covers inpatient hospital stays with a $275 copay, and outpatient services with various copays, including no copay for some services. It also includes coverage for emergency services, hearing, vision, and dental care, as well as home health services with no copay. Additional benefits include coverage for partial hospitalization, ambulance services, and diagnostic services, with varying cost-sharing requirements. The plan also provides coverage for home infusion services and medical equipment. However, some services are not covered, such as cardiac rehabilitation, and other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $275 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $375, Observation Services with a $275 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted BE WELL PLUS Tennessee (HMO C-SNP) plan, with a $60 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
The Devoted BE WELL PLUS Tennessee (HMO C-SNP) plan covers ambulance services, but requires prior authorization. Ground ambulance services have a copay between $0 and $300, and air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Devoted BE WELL PLUS Tennessee (HMO C-SNP) plan with a $125 copay, and urgently needed services have a copay between $0 and $45. Worldwide emergency services, including worldwide emergency coverage and worldwide urgent coverage, have a $125 copay, while worldwide emergency transportation has a $300 copay and 20% coinsurance.
Primary Care See details
Primary Care Physician Services, Occupational Therapy, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services have a $20 copay, while routine chiropractic care is not covered.
Preventive Services See details
The Devoted BE WELL PLUS Tennessee (HMO C-SNP) plan covers preventive services, including annual physical exams, health education, personal emergency response systems, medical nutrition therapy, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Some services are not covered, including in-home safety assessment, 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.
Hearing Services See details
Hearing exams are covered with a $20 copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with Prescription Hearing Aids (all types) covered with a copay between $199 and $499. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $20 copay, and eyewear with a combined maximum benefit of $1000 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Devoted BE WELL PLUS Tennessee (HMO C-SNP) plan covers dental services, including Medicare dental services with a $20 copay, and other dental services with a $1,000 maximum per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted BE WELL PLUS Tennessee (HMO C-SNP) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by Devoted BE WELL PLUS Tennessee (HMO C-SNP), including Durable Medical Equipment (DME) with 0-50% coinsurance and no copay, and Prosthetic Devices with 0-20% coinsurance and no copay. Medical Supplies have a 20% coinsurance and no copay. Diabetic Equipment is covered, however, Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic procedures and tests have a copay between $0 and $95, lab services have no copay, diagnostic radiological services have a copay up to $300, therapeutic radiological services have 20% coinsurance, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted BE WELL PLUS Tennessee (HMO C-SNP) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted BE WELL PLUS Tennessee (HMO C-SNP) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services are not covered, including 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 1 includes diabetic shoes and Other 2 includes $0 preventive services.
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