A non-government entity
DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 016 TN (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 C-SNP PREMIUM 016 TN (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Memphis. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED C-SNP PREMIUM 016 TN (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 C-SNP PREMIUM 016 TN (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 C-SNP PREMIUM 016 TN (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 C-SNP PREMIUM 016 TN (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $24.10. 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 $615.00 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 $5200.00 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:
Sign up for DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The prescription drug coverage for the DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 6 select care drugs at standard pharmacies and standard mail order. For Tier 1 preferred generic drugs, standard pharmacy and mail order copays start at $19 for a 1-month supply, while Tier 2 generic drugs have a $20 copay for a 1-month supply. For brand-name and specialty medications, you will pay a percentage of the drug cost rather than a flat copay. Tier 3 preferred brand drugs require a 24% coinsurance, Tier 4 non-preferred drugs require a 40% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply. These standard pharmacy and standard mail order rates help you understand your out-of-pocket medication expenses under this plan.
Additional Benefits
The DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay for primary care visits and a $30 copay for specialist consultations. If you require hospital care, inpatient stays carry a $410 copay for the first five days and no copay for days six through ninety, while emergency room visits have a $130 copay that is waived if you are admitted. Preventive care, home health services, and laboratory tests are also covered with no copay or coinsurance. For everyday wellness, the plan provides a $2,000 annual limit for covered dental care and a $300 yearly allowance for eyewear with no copays. Members also receive a $50 quarterly allowance for over-the-counter items with no copay, as well as no copay for the first 20 days of a skilled nursing facility stay. Routine hearing exams require a $30 copay, and prescription hearing aids are covered with copays ranging from $399 to $699 per device.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) with no coinsurance, requiring a $410 copay for days 1 through 5 and no copay for days 6 through 90 per stay. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $510 copay for outpatient hospital services, a $410 copay per stay for observation services, and a $30 copay for outpatient substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, though prior authorization is required for these outpatient services.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) with prior authorization, requiring a $0 to $315 copay and coinsurance for ground transport, and a 20% coinsurance and copay for air transport. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no coinsurance and a copay ranging from no copay to $45, while worldwide emergency care is covered up to $25,000 with a $130 copay and no coinsurance for emergency or urgent services and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $30 copay and no coinsurance. Additional benefits like telehealth and physical therapy feature copays ranging from $0 to $50 with no coinsurance, while some chiropractic services are covered with a $15 copay and no coinsurance, though routine and other chiropractic care are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, and fitness programs. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) covers routine hearing exams with a $30 copay and no coinsurance, plus unlimited hearing aid fitting evaluations. Prescription hearing aids are partially covered with a $399.00 to $699.00 copay and no coinsurance for up to two devices per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP), offering 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 a $300 yearly maximum allowance for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental Services are partially covered by DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP), featuring a $30 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $2,000 yearly limit. While preventive and comprehensive care like exams, cleanings, and fillings are covered, other diagnostic and preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) covers home infusion bundled services with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) covers medical equipment with no copays, though coinsurance ranges from no coinsurance up to 50% depending on the item, and prior authorization is required. Durable medical equipment carries a 20% to 50% coinsurance, while prosthetics and medical supplies range from no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with no coinsurance to 50% coinsurance for supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) with prior authorization required. Members pay no copay for lab services and outpatient X-rays, a $0 to $95 copay with no coinsurance for diagnostic procedures, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered by the DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered with no coinsurance under DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP), though only some services are covered in practice as cardiac, intensive cardiac, and pulmonary rehabilitation services (each with a $30 copay) and SET for PAD services (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) with no coinsurance and no prior three-day hospital stay required. You will pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 016 TN (HMO C-SNP) partially covers other services with no copay and no coinsurance for over-the-counter (OTC) items up to $50 every three months, non-Medicare diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and other services are not covered under this benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved