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DEVOTED CORE 010 TN (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 010 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 010 TN (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 010 TN (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Tri-Cities. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 010 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 010 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 010 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 $3900.00 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 010 TN (HMO) plan features a $375 drug deductible and offers excellent savings on generic medications. You will pay no copay for Tier 1 preferred generic drugs filled through standard pharmacies or standard mail order. For Tier 2 generic drugs, copays start at just $5 for a one-month supply, with three-month supplies costing $15 at standard pharmacies and $12.50 via standard mail order. For higher-tier medications, costs are based on coinsurance rather than set copays. Tier 3 preferred brand drugs require a 24% coinsurance, while Tier 4 non-preferred drugs carry 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.
Additional Benefits
The DEVOTED CORE 010 TN (HMO) Medicare plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance and a $275 daily copay for the first five days, followed by no copay for days six through ninety. Outpatient hospital services also feature no coinsurance, with copays ranging from no copay up to $375. Supplemental coverage under this plan includes dental benefits up to a $3,000 annual limit with no copay for preventive services and up to 50% coinsurance for comprehensive care. Vision and hearing benefits provide low copays for routine exams, a $350 annual allowance for eyewear, and affordable copays for prescription hearing aids. Members also benefit from no copay on over-the-counter items with a $100 allowance every three months.
Inpatient Hospital See details
DEVOTED CORE 010 TN (HMO) covers inpatient hospital services with no coinsurance and a copay of $275 per day for days 1 through 5, and no copay for days 6 through 90. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CORE 010 TN (HMO) with no coinsurance across all services, including ambulatory surgical center and blood services which also have no copay. Outpatient hospital services carry a copay of $0 to $375, observation services require a $275 copay per stay, and outpatient substance abuse sessions have a $25 copay.
Partial Hospitalization See details
DEVOTED CORE 010 TN (HMO) covers partial hospitalization services with an $85.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
DEVOTED CORE 010 TN (HMO) covers ambulance services with prior authorization, offering ground ambulance services with a copay of $0 to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED CORE 010 TN (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if 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 covered up to a $25,000 maximum, with a $150 copay and no coinsurance for services, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
Primary care benefits offered by DEVOTED CORE 010 TN (HMO) feature no copay and no coinsurance for primary care physician services, while specialist, therapy, and mental health services have copays ranging from $25 to $50 with no coinsurance. Telehealth services are covered with a $0 to $45 copay and no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED CORE 010 TN (HMO) with no copay and no coinsurance for covered care such as annual physical exams, fitness benefits, and kidney disease education. However, this plan does not cover in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission 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
Hearing services are covered by DEVOTED CORE 010 TN (HMO), featuring a $25 copay and no coinsurance for routine annual exams and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two aids per year, though OTC hearing aids and inner ear, outer ear, or over-the-ear prescription aids are not covered.
Vision Services See details
Vision services are covered by DEVOTED CORE 010 TN (HMO) with no deductibles, offering routine eye exams for a $0 to $25 copay and no coinsurance, though other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance, providing up to a $350 annual maximum benefit for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED CORE 010 TN (HMO) offers partially covered dental benefits up to a $3,000 annual limit, featuring no copay and no coinsurance for preventive care, and no copay with 0% to 50% coinsurance for comprehensive services. Medicare-covered dental services require a $25 copay and no coinsurance, though orthodontics, implant services, and maxillofacial prosthetics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 010 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 require no copay and no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CORE 010 TN (HMO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED CORE 010 TN (HMO) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment carries a 20% to 50% coinsurance, prosthetics and medical supplies have up to 20% coinsurance, and diabetic equipment is partially covered with up to 50% coinsurance for supplies, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 010 TN (HMO) covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $95 copay for tests, while radiological services include no-copay outpatient X-rays and therapeutic services with a minimum 20% coinsurance.
Home Health Services See details
DEVOTED CORE 010 TN (HMO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CORE 010 TN (HMO) covers some Cardiac Rehabilitation Services with a $25 copay and no coinsurance, subject to prior authorization. However, standard Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED CORE 010 TN (HMO) with no coinsurance and does not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other Services are partially covered by DEVOTED CORE 010 TN (HMO), providing additional preventive services and Over-the-Counter (OTC) items with no copay and no coinsurance, including a $100 limit every three months for OTC items. Acupuncture, meal benefits, and other services are not covered.
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