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DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO 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 CHOICE PREMIUM 012 LA (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Greater Baton Rouge. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO 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 CHOICE PREMIUM 012 LA (PPO 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 CHOICE PREMIUM 012 LA (PPO 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 CHOICE PREMIUM 012 LA (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $32.90. 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 $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 combined Maximum Out-Of-Pocket cost of $9850.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $9850.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) plan features an annual drug deductible of $615. Under this plan, you will pay no copay for Tier 6 Select Care Drugs through standard pharmacy or standard mail order services. For Tier 1 Preferred Generic and Tier 2 Generic medications, standard pharmacy and mail order costs start at an $18 and $19 copay respectively for a one-month supply. For brand-name and specialty medications, costs are structured as a percentage of the drug cost rather than a flat copay. Tier 3 Preferred Brand drugs require a 21% coinsurance, while Tier 4 Non-Preferred drugs carry a 33% coinsurance. Tier 5 Specialty medications incur a 25% coinsurance for a one-month supply through standard pharmacies and mail order.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits and routine preventive services. For specialist visits, patients can expect a copay between $40 and $50, while inpatient hospital stays require a $275 daily copay for the first several days before transitioning to no copay. Emergency room visits carry a $130 copay, which is waived if admitted, and urgent care ranges from no copay up to $45. This plan also includes valuable everyday benefits, such as a $2,500 annual dental allowance with no copay for most covered services and a $300 annual limit for eyewear with no copay. Hearing aid coverage features copays ranging from $399 to $699 per aid, alongside a $50 quarterly allowance for over-the-counter items. Medical equipment and dialysis services are covered with no copay, though they require coinsurance ranging from 20% to 40% depending on the item.
Inpatient Hospital See details
Inpatient hospital care is covered by DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) with no coinsurance, requiring a $275 copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for remaining days. Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center and outpatient blood services which both require no copay. Medicare-covered outpatient hospital services have a copay of $0.00 to $375.00, observation services require a $275.00 copay per stay, and outpatient substance abuse sessions carry a $40.00 copay.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) with prior authorization required for all ambulance services. Ground ambulance services require coinsurance alongside a copay ranging from no copay to $405.00, while air ambulance services require a 20% coinsurance and a copay. Additionally, some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services feature no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with a $130 copay and no coinsurance for emergency or urgent care, and a $405 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist, therapy, mental health, and psychiatric services require copays between $40 and $50 with no coinsurance. Telehealth services are available with no copay to a $45 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) covers preventive services, including annual physical exams, kidney disease education, and cardiovascular screenings, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, offering benefits like fitness programs and nutritional therapy, while sub-services such as in-home safety assessments, therapeutic massages, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) provides partially covered hearing services, including one routine hearing exam per year for a $40 copay and no coinsurance, plus unlimited fitting evaluations. Prescription hearing aids are covered with no coinsurance and a copay ranging from $399 to $699 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP), excluding other eye exam services. Covered eye exams carry a $0 to $40 copay, no coinsurance, and no deductible, while eyewear is covered with no copay, no coinsurance, no deductible, and a $300 annual limit.
Dental Services See details
Dental Services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP), offering up to a $2,500 annual maximum benefit for both in-network and out-of-network care. Covered Medicare dental services require a $40 copay and no coinsurance, while other covered dental services have no copay and no coinsurance. Other diagnostic, other preventive, maxillofacial prosthetics, implant, and orthodontic services are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) covers Home Infusion bundled Services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance, while Part B insulin drugs require a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment carries a 20% to 35% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 40% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) covers diagnostic and radiological services with prior authorization required. Lab services and outpatient X-rays have no copay, diagnostic tests and procedures range from no copay up to a $95 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) with no copay and no coinsurance, although prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered in practice.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) with no coinsurance, requiring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, but a prior three-day hospital stay is not, and additional days beyond Medicare coverage are not covered.
Other Services See details
DEVOTED C-SNP CHOICE PREMIUM 012 LA (PPO C-SNP) partially covers other services, offering over-the-counter (OTC) items up to $50 every three months, diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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