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DEVOTED PREMIUM 002 TX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED PREMIUM 002 TX (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED PREMIUM 002 TX (HMO) in 2026, please refer to our full plan details page.
DEVOTED PREMIUM 002 TX (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 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 PREMIUM 002 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 PREMIUM 002 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 PREMIUM 002 TX (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $4150.00 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 PREMIUM 002 TX (HMO) plan has an annual prescription drug deductible of $615. Under this plan, Tier 1 preferred generic drugs have no copay for one-, two-, or three-month supplies filled at standard retail pharmacies or through standard mail order. Tier 2 generic drugs are also very affordable, with copays starting at $3 for a one-month supply at standard retail pharmacies and standard mail order. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copayments. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty medications carry a 25% coinsurance. Specialty drugs are limited to a one-month supply, helping members plan their monthly healthcare expenses.
Additional Benefits
The DEVOTED PREMIUM 002 TX (HMO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits and preventive services, while specialist visits require a $25 copay. Inpatient hospital stays cost a $325 daily copay for the first five days and no copay for days six through 90. Outpatient services feature no coinsurance, with costs ranging from no copay up to a $425 copay depending on the service. This plan also includes valuable supplemental benefits, such as dental coverage up to a $3,000 annual limit with no copay for preventive care and 0% to 50% coinsurance for comprehensive services. Vision care features a $250 yearly eyewear allowance with no copay, while hearing exams require a $25 copay and prescription hearing aids have copays ranging from $199 to $499. Additionally, members receive home health services with no copay and a quarterly allowance of $40 for over-the-counter items.
Inpatient Hospital See details
DEVOTED PREMIUM 002 TX (HMO) covers inpatient hospital acute and psychiatric services with no coinsurance, requiring a $325 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional days are covered for acute care, non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED PREMIUM 002 TX (HMO) covers outpatient services with no coinsurance, offering ambulatory surgical center and outpatient blood services with no copay. Outpatient hospital services carry a copay of $0 to $425 (including $325 per stay for observation), and outpatient substance abuse individual or group sessions require a $25 copay.
Partial Hospitalization See details
DEVOTED PREMIUM 002 TX (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED PREMIUM 002 TX (HMO) with prior authorization, requiring no copay to a $325 copay plus coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. Transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED PREMIUM 002 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 no copay to a $45 copay and no coinsurance. Worldwide emergency and urgent services are covered up to a $25,000 limit with a $150 copay and no coinsurance, while worldwide emergency transportation requires a $325 copay and 20% coinsurance.
Primary Care See details
Primary care benefits under the DEVOTED PREMIUM 002 TX (HMO) plan feature no copay and no coinsurance for primary care physician visits, while specialist visits, mental health, and psychiatric services have a $25 copay with no coinsurance. Physical, occupational, and speech therapy services require a $25 to $50 copay with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by DEVOTED PREMIUM 002 TX (HMO) with no copay and no coinsurance for services such as annual physical exams, kidney disease education, and diabetes self-management. This benefit is partially covered, as fitness benefits, weight management, and alternative therapies are included, while services like in-home safety assessments, personal emergency response systems, therapeutic massage, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are covered by DEVOTED PREMIUM 002 TX (HMO) with a $25 copay and no coinsurance for exams, and a $199 to $499 copay and no coinsurance for prescription hearing aids. This benefit is partially covered because OTC hearing aids, along with inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED PREMIUM 002 TX (HMO) offers partially covered vision services, including one annual routine eye exam with a $0 to $25 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance, up to a $250 yearly maximum benefit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED PREMIUM 002 TX (HMO), featuring a $3,000 annual maximum with no copay and no coinsurance for preventive care, and a $25 copay with no coinsurance for Medicare-covered dental. Comprehensive services have no copay and 0% to 50% coinsurance, though maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED PREMIUM 002 TX (HMO) with no copay, although prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, are covered with 0% to 20% coinsurance, with insulin also carrying a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED PREMIUM 002 TX (HMO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
DEVOTED PREMIUM 002 TX (HMO) partially covers medical equipment with no copays, though prior authorization is required. Covered durable medical equipment carries a 20% to 50% coinsurance, while prosthetic devices, medical supplies, and diabetic supplies range from no coinsurance to 20% or 50% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED PREMIUM 002 TX (HMO) covers diagnostic and radiological services with prior authorization, offering lab services with no copay or coinsurance and outpatient X-rays with no copay. Diagnostic procedures and tests range from a $0 to $150 copay with no coinsurance, while diagnostic radiological services start at a $0 copay and therapeutic radiology requires a minimum 20% coinsurance and a copay.
Home Health Services See details
Home Health Services are covered under the DEVOTED PREMIUM 002 TX (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED PREMIUM 002 TX (HMO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry a $25 copay.
Skilled Nursing Facility (SNF) See details
DEVOTED PREMIUM 002 TX (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a daily copay of $218 for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED PREMIUM 002 TX (HMO) provides partial coverage for other services, featuring additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance. OTC items are limited to a maximum benefit of $40 every three months, while acupuncture and meal benefits are not covered.
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