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DEVOTED C-SNP CHOICE PREMIUM 013 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 013 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 013 LA (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 013 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 New Orleans. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 013 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 013 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 013 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 013 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:
Sign up for DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO 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 DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) prescription drug plan has an annual drug deductible of $615. For standard pharmacies and standard mail-order services, Tier 6 select care drugs are covered with no copay for one-, two-, or three-month supplies. Tier 1 preferred generic drugs require an $18 copay per month, while Tier 2 generic drugs carry a $19 copay per month. Brand-name and specialty medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brand drugs require a 21% coinsurance, Tier 4 non-preferred drugs require a 33% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) plan offers comprehensive medical coverage, including primary care visits and preventive services with no copay and no coinsurance. For specialized care, members pay a $40 copay for specialist visits and a $130 copay for emergency room services, which is waived if admitted. Inpatient hospital stays require a $275 daily copay for the first several days, while home health services are available with no copay or coinsurance. This plan also features valuable supplemental benefits, such as dental coverage up to $2,500 annually and vision eyewear up to $300 annually with no copay or coinsurance. Routine hearing exams carry a $40 copay, and up to two prescription hearing aids are covered each year with copays ranging from $399 to $699. Additionally, members receive an allowance of $50 every three months for over-the-counter items with no copay.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 through 6 for acute stays (no copay for days 7 through 90) and a $275 daily copay for days 1 through 5 for psychiatric stays (no copay for days 6 through 90). This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services covered by the DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) plan feature no coinsurance, with outpatient hospital copays ranging from $0 to $375 and observation services costing a $275 copay per stay. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while individual and group outpatient substance abuse sessions carry a $40 copay. Prior authorization is required for these covered outpatient benefits.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) covers ambulance services with prior authorization, offering ground ambulance services for a $0 to $405 copay with no coinsurance and air ambulance services for a 20% coinsurance with no copay. Transportation services are not covered under this plan.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 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 require no copay to a $45 copay with no coinsurance, while worldwide emergency services are covered up to $25,000 with copays up to $405 and up to 20% coinsurance.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $40 copay and no coinsurance. Additional services like therapy, mental health, and telehealth have copays ranging from $0 to $50 with no coinsurance, though routine and other chiropractic services are not covered.
Preventive Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. While fitness and weight management programs are included, the benefit is partially covered as sub-services like in-home support, therapeutic massage, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) covers hearing services with a $40 copay and no coinsurance for routine exams, with no deductible. Up to two prescription hearing aids are covered annually with no coinsurance and copays ranging from $399 to $699, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP), which offers eye exams with a $0 to $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $300 annual maximum for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) provides partially covered dental services with a $40 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered preventive and comprehensive services up to a $2,500 yearly maximum. Sub-services that are not covered under this plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) covers home infusion bundled services with no copay, subject to prior authorization. Under this benefit, Part B chemotherapy, radiation, and other drugs require no copay and up to 20% coinsurance (with a minimum of no coinsurance), while Part B insulin drugs carry a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) covers medical equipment with no copays, though prior authorization is required for these benefits. Durable medical equipment carries a 20% to 50% coinsurance, and 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 CHOICE PREMIUM 013 LA (PPO C-SNP) with prior authorization required. Diagnostic services have no coinsurance, featuring no copay for lab services and a copay ranging from $0 to $95 for diagnostic procedures and tests. Radiological services feature no copay for outpatient X-rays, a copay starting at $0 for diagnostic radiological services, and a minimum 20% coinsurance for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) offers Cardiac Rehabilitation Services with no coinsurance, but in practice only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require copayments ranging from $25 to $40.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services covered by DEVOTED C-SNP CHOICE PREMIUM 013 LA (PPO C-SNP) include over-the-counter items up to $50 every three months, non-Medicare diabetic shoes, and additional preventive services, all with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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* 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.
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