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DEVOTED DUAL 012 TX (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED DUAL 012 TX (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED DUAL 012 TX (HMO D-SNP) in 2026, please refer to our full plan details page.
DEVOTED DUAL 012 TX (HMO D-SNP) is a HMO D-SNP 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 DUAL 012 TX (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED DUAL 012 TX (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED DUAL 012 TX (HMO D-SNP).
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 DUAL 012 TX (HMO D-SNP), 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 $9250.00 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 DUAL 012 TX (HMO D-SNP) prescription drug plan features an annual drug deductible of $615. When filling prescriptions at preferred pharmacies or through preferred mail-order services, you will pay no copay or coinsurance across all drug tiers. For standard pharmacies and standard mail-order options, a 25% coinsurance applies to Tier 1 through Tier 4 medications, as well as 1-month supplies of Tier 5 specialty drugs. Additionally, Tier 6 select care drugs are highly accessible, offering no copay for 1-month, 2-month, and 3-month supplies at both standard and preferred pharmacies. This plan structure helps beneficiaries maximize their savings on essential prescriptions by utilizing preferred network pharmacies.
Additional Benefits
The DEVOTED DUAL 012 TX (HMO D-SNP) plan offers comprehensive medical coverage featuring no copays for primary care visits, home health services, and outpatient care, though outpatient services may carry up to a 20% coinsurance. Inpatient hospital stays require a $2,080 copay per stay with no coinsurance, while emergency room visits have a $115 copay that is waived if you are admitted. Specialist visits and diagnostic services generally require no copay but are subject to a 20% coinsurance. For supplemental care, the plan provides routine dental, vision, and hearing benefits with no copays, though some services require a 20% coinsurance and dental services have a $2,000 annual limit. Additionally, members can access a $400 annual eyewear allowance and a $50 quarterly allowance for over-the-counter products with no copays or coinsurance. Prescription hearing aids are also covered with copays ranging from $399 to $699.
Inpatient Hospital See details
DEVOTED DUAL 012 TX (HMO D-SNP) partially covers inpatient hospital services with a $2,080 copay per stay, no coinsurance, and prior authorization required. While unlimited additional acute days are covered, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers outpatient services with no copays, with coinsurance ranging from no coinsurance up to 20% depending on the specific service. Covered benefits include outpatient hospital, ambulatory surgical center, substance abuse, and blood services, most of which require prior authorization.
Partial Hospitalization See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers ground ambulance services with no copay and no coinsurance to 20% coinsurance, and air ambulance services with no copay and 20% coinsurance, both requiring prior authorization. Transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers emergency services with a $115 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, and urgently needed services with no copay and 0% to 20% coinsurance up to $40. Worldwide emergency, urgent, and transportation services are also covered with no copay and no coinsurance up to a $25,000 maximum benefit limit.
Primary Care See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers primary care physician services with no copay and no coinsurance. Most specialist, therapy, and mental health services are covered with no copay and 20% coinsurance, though chiropractic care is only partially covered and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED DUAL 012 TX (HMO D-SNP) with no copay and no coinsurance for covered benefits like annual physical exams, fitness programs, and nutritional counseling. However, several additional services are not covered, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and therapeutic massages.
Hearing Services See details
Hearing services are partially covered by DEVOTED DUAL 012 TX (HMO D-SNP), featuring routine hearing exams with no copay and a 20% coinsurance, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $399 to $699, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
DEVOTED DUAL 012 TX (HMO D-SNP) features partially covered vision services, as other eye exam services are not covered. Covered routine eye exams have no copay and 0% to 20% coinsurance with no deductible, while eyewear is covered with no copay, no coinsurance, and no deductible up to a $400 annual maximum.
Dental Services See details
DEVOTED DUAL 012 TX (HMO D-SNP) offers partially covered dental services with no copay and 20% coinsurance for Medicare-covered care, and no copay or coinsurance for other covered services up to a $2,000 annual limit. Non-covered services include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers Home Infusion bundled Services with no copay, though prior authorization and step therapy may be required. Covered Medicare Part B drugs, including chemotherapy and radiation, carry a coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED DUAL 012 TX (HMO D-SNP) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers medical equipment, including durable medical equipment (DME), prosthetics, medical supplies, and diabetic equipment, with no copay and prior authorization required. Coinsurance for these covered benefits ranges from 0% (no coinsurance) to 18% depending on the specific item.
Diagnostic and Radiological Services See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers diagnostic and radiological services with prior authorization required and no copays. There is no coinsurance for diagnostic procedures and tests, while lab services, diagnostic and therapeutic radiological services, and outpatient X-ray services are subject to a 20% coinsurance.
Home Health Services See details
Home health services are covered by DEVOTED DUAL 012 TX (HMO D-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers some cardiac rehabilitation services with no copay and prior authorization, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
DEVOTED DUAL 012 TX (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary for admission, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED DUAL 012 TX (HMO D-SNP) partially covers other services, offering additional preventive services and over-the-counter (OTC) items with no copay and no coinsurance, including a $50 allowance every three months for OTC products. Acupuncture, meal benefits, and highly integrated dual-eligible SNP services are not covered.
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