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DEVOTED CORE 009 TN (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 009 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 009 TN (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 009 TN (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Chattanooga. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 009 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 009 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 009 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 $4500.00 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 009 TN (HMO) plan features a drug deductible of $375. Tier 1 preferred generic drugs offer excellent savings with no copay for 1-month, 2-month, or 3-month supplies at standard pharmacies and through mail order. Tier 2 generic drugs are also highly affordable, with standard pharmacy copays ranging from $5 to $15 and mail order copays capped at $12.50 for a 3-month supply. Brand-name and specialty medications on this plan are covered under coinsurance rather than set copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs have a 25% coinsurance for standard pharmacy and mail order fills. Specialty drugs in Tier 5 carry a 28% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED CORE 009 TN (HMO) plan offers affordable essential medical coverage, featuring no copay and no coinsurance for primary care visits and preventive services. Specialist visits require a $30 copay, while inpatient hospital stays carry a $295 daily copay for the first five days and no copay for days six through 90. Emergency room visits have a $130 copay, which is waived if you are admitted to the hospital within 24 hours. For extra health benefits, this plan provides up to $3,500 annually for preventive dental care with no copay or coinsurance, alongside comprehensive dental coverage with 0% to 50% coinsurance. Vision services feature up to a $350 yearly allowance for eyewear with no copay or coinsurance, while prescription hearing aids require a copay between $399 and $699. Members also receive up to $100 every three months for over-the-counter items with no copay and no coinsurance.
Inpatient Hospital See details
DEVOTED CORE 009 TN (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $295 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and some services are not covered, including upgrades, non-Medicare-covered stays, and additional psychiatric days.
Outpatient Services See details
Outpatient services covered by DEVOTED CORE 009 TN (HMO) feature no coinsurance across all benefits, including no copays for ambulatory surgical center and blood services. Outpatient hospital services require a copay of $0 to $395, observation services carry a $295 copay per stay, and outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
DEVOTED CORE 009 TN (HMO) covers partial hospitalization services with an $85.00 copay and no coinsurance. Prior authorization is required to receive this care.
Ambulance and Transportation Services See details
DEVOTED CORE 009 TN (HMO) covers ground ambulance services with prior authorization and a copay ranging from no copay to $315, while air ambulance services require a 20% coinsurance. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 009 TN (HMO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours, and urgently needed services with a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency and urgent care are also 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 009 TN (HMO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Additional services like physical therapy, occupational therapy, and telehealth have copays ranging from $0 to $50 with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
DEVOTED CORE 009 TN (HMO) offers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are only partially covered, excluding in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote technologies, and counseling.
Hearing Services See details
DEVOTED CORE 009 TN (HMO) offers partially covered hearing services, including routine hearing exams for a $30 copay and no coinsurance, and prescription hearing aids with copays ranging from $399 to $699 and no coinsurance. Under this plan, OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED CORE 009 TN (HMO) vision services are partially covered, offering one annual routine eye exam with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $350 yearly maximum benefit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 009 TN (HMO), offering up to $3,500 in annual benefits with no copay and no coinsurance for preventive care, and a $30 copay with no coinsurance for Medicare-covered dental. Comprehensive services feature no copay and 0% to 50% coinsurance, but maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 009 TN (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED CORE 009 TN (HMO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
Medical equipment is covered by the DEVOTED CORE 009 TN (HMO) plan with no copays, featuring 20% to 50% coinsurance for durable medical equipment 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 covered diabetic supplies require no coinsurance to 50% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED CORE 009 TN (HMO) with prior authorization required, featuring no copay for lab services and outpatient X-rays. Diagnostic procedures and tests carry a copay of $0 to $95 with no coinsurance, diagnostic radiological services have copays starting at $0, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CORE 009 TN (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED CORE 009 TN (HMO) with no coinsurance and require prior authorization, though only some services are covered. Specifically, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, and Pulmonary Rehabilitation are not covered and require a $30 copay, while Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) is not covered and requires a $25 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 009 TN (HMO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other Services are partially covered by DEVOTED CORE 009 TN (HMO), offering no copay and no coinsurance for additional preventive services and Over-the-Counter (OTC) items up to a $100 limit every three months. However, acupuncture, meal benefits, and other select services are not covered.
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