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Devoted PREMIUM Greater Houston (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted PREMIUM Greater Houston (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted PREMIUM Greater Houston (HMO) in 2025, please refer to our full plan details page.
Devoted PREMIUM Greater Houston (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 4.5 out of 5 stars in 2025.
It's important to know that Devoted PREMIUM Greater Houston (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 Greater Houston (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 Greater Houston (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $7.20. 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 $590.00 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 Greater Houston (HMO) plan has a $590 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, a standard pharmacy will charge a $5 copay for tier 1 drugs, while tier 2 drugs will have 25% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, and you will pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy (LIS), you may have a reduced premium.
Additional Benefits
The Devoted PREMIUM Greater Houston (HMO) plan offers a wide range of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. The plan also covers primary care, preventive, hearing, vision, and dental services, with copays for most services. Additionally, the plan includes coverage for ambulance, emergency, home health, and skilled nursing facility services, with specific copay and coinsurance amounts outlined in the plan details.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $425 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $425, observation services with a $325 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with a waived three-pint deductible. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted PREMIUM Greater Houston (HMO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted PREMIUM Greater Houston (HMO) plan. Ground Ambulance Services have a copay of $0-$325, while Air Ambulance Services have a 20% coinsurance; however, Transportation Services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Devoted PREMIUM Greater Houston (HMO) plan. Emergency Services has a $140 copay, and Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Services has a $140 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $325 copay with 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Devoted PREMIUM Greater Houston (HMO) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with a copay between $0 and $50, Physician Specialist Services with a $0-$25 copay, Mental Health Specialty Services with a $25 copay for individual and group sessions, Other Health Care Professional with a $0-$25 copay, Psychiatric Services with a $25 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a $0-$50 copay, Additional Telehealth Benefits with a $0-$25 copay, and Opioid Treatment Program Services with a $25 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The Devoted PREMIUM Greater Houston (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services such as health education, personal emergency response systems, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. In-home safety assessments, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay, including routine hearing exams once per year and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $199 and $499 for up to two hearing aids every year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services with Devoted PREMIUM Greater Houston (HMO) include eye exams with a $25 copay, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $500 every year.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a $25 copay, and other services such as Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Fluoride Treatment, Other Preventive Dental Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery. Prophylaxis (Cleaning) is limited to 2 visits per year. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. Orthodontic Services have a maximum benefit of $500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Devoted PREMIUM Greater Houston (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and 20% coinsurance; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted PREMIUM Greater Houston (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 50%, Prosthetic Devices with a coinsurance between 0% and 20%, and Medical Supplies with a 20% coinsurance; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Devoted PREMIUM Greater Houston (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $200, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Devoted PREMIUM Greater Houston (HMO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Devoted PREMIUM Greater Houston (HMO) covers Cardiac Rehabilitation Services, but the specific services are not covered. The plan mentions that there is a copay for some services, but does not specify the amount.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted PREMIUM Greater Houston (HMO) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The "Other Services" benefit for Devoted PREMIUM Greater Houston (HMO) does not cover acupuncture, over-the-counter items, or a meal benefit. Other services covered include $0 preventive services, and no authorization or referrals are required.
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