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DEVOTED CORE 003 TX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 003 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 003 TX (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 003 TX (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 5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 003 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 003 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 003 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
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 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 003 TX (HMO) plan features a $0 drug deductible, meaning your prescription drug coverage begins immediately without any out-of-pocket deductible costs. Under this plan, you will pay no copay for Tier 1 preferred generic and Tier 2 generic medications when using standard pharmacies or standard mail order. For brand-name and specialty medications, your costs are determined by a coinsurance percentage. You will pay a 24% coinsurance for Tier 3 preferred brand drugs, a 43% coinsurance for Tier 4 non-preferred drugs, and a 33% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The DEVOTED CORE 003 TX (HMO) plan offers affordable medical coverage with no copay for primary care visits and a $20 copay for specialists. Inpatient hospital stays require a $150 daily copay for the first five days and no copay thereafter, while emergency room visits carry a $150 copay that is waived if you are admitted. Outpatient services and preventive care are highly accessible, featuring no coinsurance and no copays for many services. This plan also provides robust supplemental benefits, including a generous dental allowance of up to $4,000 annually with no copay for most preventive services. Vision and hearing benefits feature routine exams with copays up to $20, a $300 annual limit for eyewear with no copay, and prescription hearing aids starting at a $399 copay. Additionally, members receive a $100 allowance every three months for over-the-counter health items with no copay.
Inpatient Hospital See details
DEVOTED CORE 003 TX (HMO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $150 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional days for psychiatric stays are not covered, and prior authorization is required.
Outpatient Services See details
DEVOTED CORE 003 TX (HMO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Medicare-covered outpatient hospital services require a copay of $0 to $250 ($150 per stay for observation), and outpatient substance abuse sessions have a $20 copay, with no coinsurance for any of these services.
Partial Hospitalization See details
DEVOTED CORE 003 TX (HMO) covers partial hospitalization services with a $35.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
DEVOTED CORE 003 TX (HMO) covers ambulance services with prior authorization, requiring a copay ranging from no copay to $315 for ground ambulance and a 20% coinsurance with no copay for air ambulance. Although transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED CORE 003 TX (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services range from no copay to a $45 copay with no coinsurance. Worldwide emergency services are covered up to $25,000, with a $150 copay for emergency and urgent care, and a $315 copay with 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 003 TX (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Other covered benefits like physical, occupational, mental health, and telehealth services feature copays ranging from $0 to $50 and no coinsurance, though podiatry is not covered, and routine and other chiropractic services are also not covered.
Preventive Services See details
Preventive services under DEVOTED CORE 003 TX (HMO) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered, excluding services such as in-home support, personal emergency response systems, therapeutic massage, and medical nutrition therapy.
Hearing Services See details
DEVOTED CORE 003 TX (HMO) hearing services are partially covered, offering routine hearing exams for a $20 copay and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are covered for a copay of $399 to $699 with no coinsurance for up to two aids per year, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
DEVOTED CORE 003 TX (HMO) vision services are partially covered, featuring routine eye exams with a $0 to $20 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a $300 annual maximum limit for contacts, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 003 TX (HMO) up to a $4,000 yearly maximum. Medicare-covered dental services require a $20 copay and no coinsurance, while other covered diagnostic, preventive, and comprehensive services have no copay and coinsurance ranging from no coinsurance to 50%. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED CORE 003 TX (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs have a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED CORE 003 TX (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is covered by DEVOTED CORE 003 TX (HMO) with no copays and varying coinsurance, subject to prior authorization. Durable medical equipment requires 20% to 50% coinsurance, prosthetics and medical supplies carry no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with no coinsurance to 50% coinsurance for supplies, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 003 TX (HMO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $95 copay for diagnostic procedures. Covered radiological services require prior authorization and include outpatient X-rays with no copay, diagnostic radiology with copays starting at $0, and therapeutic radiology with a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CORE 003 TX (HMO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED CORE 003 TX (HMO) covers some cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED CORE 003 TX (HMO) with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. 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.
Other Services See details
Other Services are partially covered by DEVOTED CORE 003 TX (HMO), which offers over-the-counter (OTC) items up to $100 every three months and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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