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DEVOTED CORE 001 TX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 001 TX (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 001 TX (HMO) in 2026, please refer to our full plan details page.
This summary reflects 2026 plan information. Where this plan continues in 2027, the full plan details page links to its 2027 benefits and costs.
DEVOTED CORE 001 TX (HMO) is a HMO plan offered by Devoted Health Plan of Texas, Inc. available for the 2026 plan year to people living in Houston. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 001 TX (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 001 TX (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 001 TX (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
Health deductible: information not available.
This plan has a $240.00 drug deductible that applies only to drugs in certain tiers. You pay this amount toward covered prescriptions in those tiers before the plan's cost sharing begins; drugs in the other tiers are not subject to the deductible. See the full plan details page for the tier table.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3650.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your out-of-pocket costs reach $3650.00 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 001 TX (HMO) Medicare plan features an annual drug deductible of $240. Under this plan, you will pay no copay for Tier 1 (Preferred Generic) and Tier 2 (Generic) medications for 1-month, 2-month, or 3-month supplies filled at standard pharmacies or through standard mail order. For higher-tier medications, cost-sharing is based on coinsurance percentages at standard pharmacies and standard mail order. You will pay a 20% coinsurance for Tier 3 Preferred Brand drugs, a 25% coinsurance for Tier 4 Non-Preferred drugs, and a 29% coinsurance for a 1-month supply of Tier 5 Specialty Tier drugs.
Additional Benefits
The DEVOTED CORE 001 TX (HMO) plan offers robust medical coverage with predictable costs, including no copay for primary care visits and a $25 copay for specialist appointments. For inpatient hospital stays, members pay a $325 copay per stay with no coinsurance, while outpatient hospital services feature copays ranging from no copay to $425. Emergency room visits require a $150 copay, which is waived if you are admitted to the hospital within 24 hours. In addition to standard medical care, this plan provides valuable extra benefits like preventive dental care with no copay and up to a $3,000 annual limit for comprehensive services. Vision care includes routine exams with a copay ranging from no copay to $25, plus a $350 annual allowance for eyewear with no copay or deductible. Members also benefit from a $200 over-the-counter allowance every three months and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
DEVOTED CORE 001 TX (HMO) partially covers inpatient hospital care, requiring a $325 copayment per stay and no coinsurance for acute and psychiatric admissions. While unlimited additional acute days are covered, non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED CORE 001 TX (HMO) covers outpatient services with no coinsurance, featuring a copay ranging from $0 to $425 for outpatient hospital services and a $325 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the DEVOTED CORE 001 TX (HMO) plan with a $55.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED CORE 001 TX (HMO), featuring ground ambulance services with no copay to a $325 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, while transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 001 TX (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 $25,000 with a $150 copay and no coinsurance, while worldwide emergency transportation has a $325 copay and 20% coinsurance.
Primary Care See details
DEVOTED CORE 001 TX (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits for a $25 copay and no coinsurance. Additional benefits like therapy, mental health, and telehealth are covered with copays ranging from $0 to $50 and no coinsurance, while podiatry is not covered and chiropractic benefits cover some services but exclude routine and other chiropractic care.
Preventive Services See details
DEVOTED CORE 001 TX (HMO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. While additional benefits like fitness and weight management programs are included, some services such as in-home support, therapeutic massage, and personal emergency response systems are not covered.
Hearing Services See details
DEVOTED CORE 001 TX (HMO) partially covers hearing services, featuring routine hearing exams for a $25 copay and no coinsurance, and up to two prescription hearing aids per year with a $399 to $699 copay and no coinsurance. Fitting and evaluation services are covered, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
DEVOTED CORE 001 TX (HMO) provides partially covered vision services, featuring one routine eye exam per year with a $0 to $25 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Covered eyewear, including contacts, lenses, and frames, has no copay, no coinsurance, and no deductible up to a $350 maximum annual benefit.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 001 TX (HMO) up to a $3,000 annual limit, with no copay and no coinsurance for preventive care, periodontics, and oral surgery. Medicare-covered dental services require a $25 copay and no coinsurance, while restorative, endodontic, and prosthodontic services have no copay and 0% to 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 001 TX (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
DEVOTED CORE 001 TX (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these covered services.
Medical Equipment See details
Medical equipment is covered by DEVOTED CORE 001 TX (HMO) with no copays, requiring prior authorization and coinsurance of 20% to 50% for durable medical equipment, up to 20% for prosthetics and medical supplies, and up to 50% for diabetic supplies. Diabetic equipment is only partially covered under this plan, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 001 TX (HMO) covers diagnostic and radiological services, offering lab services and outpatient X-rays with no copay and diagnostic procedures with a copay of $0 to $150 and no coinsurance. Diagnostic radiological services have a copay starting at $0, while therapeutic radiological services require 20% coinsurance.
Home Health Services See details
DEVOTED CORE 001 TX (HMO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by DEVOTED CORE 001 TX (HMO) with no coinsurance and require prior authorization. While some services are covered, specific sub-services including cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and carry a $25 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 001 TX (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare limit.
Other Services See details
Other Services are partially covered by DEVOTED CORE 001 TX (HMO), featuring no copay and no coinsurance for additional preventive services and over-the-counter (OTC) items, which have a $200 maximum limit every three months. Acupuncture and meal benefits are not covered under this plan.
Plan Providers
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpringSM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.
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