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Devoted CORE San Antonio (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted CORE San Antonio (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted CORE San Antonio (HMO) in 2025, please refer to our full plan details page.
Devoted CORE San Antonio (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in San Antonio. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Devoted CORE San Antonio (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 San Antonio (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 San Antonio (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
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 CORE San Antonio (HMO) plan has an enhanced alternative drug benefit. The plan has a deductible of $590.00. During the initial coverage phase, after you meet your deductible, you'll pay varying costs based on the drug tier and pharmacy type, including no copay for some preferred generics at standard and mail order pharmacies, and 25% coinsurance for other tiers. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Devoted CORE San Antonio (HMO) plan offers a variety of benefits, including inpatient hospital stays with a copay, and outpatient services with varying copays. You'll have access to primary care, preventive, hearing, vision, and dental services. The plan also covers ambulance services, emergency services, and home health services. It's important to note that some services require prior authorization, and there are copays and coinsurance amounts associated with different services.
Inpatient Hospital See details
The Devoted CORE San Antonio (HMO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For days 1-5, there is a $150 copay, and days 6-90 have no copay. Additional days for Inpatient Hospital-Acute are covered with no copay.
Outpatient Services See details
Outpatient Services includes coverage for outpatient hospital services with a copay between $0 and $250, observation services with a $150 copay, and ambulatory surgical center services with no copay. Individual and group sessions for outpatient substance abuse have a copay of $25, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted CORE San Antonio (HMO) plan, but requires prior authorization. The copay for this benefit is $35.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted CORE San Antonio (HMO) plan. Ground ambulance services have a copay between $0 and $275, while air ambulance services have a 20% coinsurance, and transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Devoted CORE San Antonio (HMO) plan. Emergency Services have a $140 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $45, and no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $140 copay and no coinsurance, while Worldwide Emergency Transportation has a $275 copay and 20% coinsurance, with a maximum benefit of $25,000.
Primary Care See details
The Devoted CORE San Antonio (HMO) plan covers primary care physician services, chiropractic services, occupational therapy, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits and opioid treatment program services. Chiropractic services have a $20 copay, while physician specialist services have a $0-$25 copay, and individual and group mental health and psychiatric sessions have a $25 copay.
Preventive Services See details
The Devoted CORE San Antonio (HMO) plan covers preventive services including annual physical exams, health education, personal emergency response systems, weight management programs, alternative therapies, nutritional/dietary benefits, fitness benefits, home and bathroom safety devices and modifications, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs 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, counseling services, telemonitoring services, remote access technologies and enhanced disease management are not covered.
Hearing Services See details
Hearing services include hearing exams with a $25 copay, and prescription hearing aids with a copay between $399 and $699, while OTC hearing aids are not covered. Routine hearing exams are limited to one per year, and fitting/evaluation for hearing aids are unlimited, while prescription hearing aids are limited to two per year. Prescription hearing aids for the inner, outer, and over the ear are not covered.
Vision Services See details
Vision services include eye exams with a $25 copay, and coverage for eyewear with a combined maximum benefit of $1,000 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a $1,000 annual maximum benefit. Medicare dental services have a $25 copay, while other dental services include oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Devoted CORE San Antonio (HMO) plan and require prior authorization. Insulin has a $35 copay and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation and other Medicare Part B Drugs have between 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Devoted CORE San Antonio (HMO) plan. The coinsurance for dialysis services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits, including Durable Medical Equipment (DME) with a coinsurance between 0% and 50%, are covered by Devoted CORE San Antonio (HMO). Prosthetic Devices have a coinsurance between 0% and 20%, and Medical Supplies have a 20% coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $95, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $300, Therapeutic Radiological Services with at least 20% coinsurance, and Outpatient X-Ray Services with no copay. Prior authorization is required.
Home Health Services See details
Home Health Services are covered by the Devoted CORE San Antonio (HMO) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Devoted CORE San Antonio (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted CORE San Antonio (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services offered by the Devoted CORE San Antonio (HMO) plan include some services that are not covered, such as acupuncture, over-the-counter items, and a meal benefit. The plan also does not cover Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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