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DEVOTED CORE 014 TX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 014 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 014 TX (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 014 TX (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Austin. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 014 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 014 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 014 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 a $305.00 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 $5400.00 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 014 TX (HMO) plan features an annual drug deductible of $305. Beneficiaries enjoy no copay for Tier 1 preferred generic and Tier 2 generic drugs when using standard pharmacies or standard mail order. This $0 cost-sharing applies to one-month, two-month, and three-month supply options. For brand-name and specialty prescriptions, costs are calculated as a percentage of the drug cost. Tier 3 preferred brand drugs require a 19% coinsurance, while Tier 4 non-preferred drugs have a 25% coinsurance. Specialty Tier 5 medications require a 28% coinsurance for a one-month supply at standard pharmacies or via standard mail order.
Additional Benefits
The DEVOTED CORE 014 TX (HMO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, annual physical exams, and routine preventive services. For specialist visits, members can expect copays ranging from $35 to $50 with no coinsurance. Inpatient hospital stays require a $280 daily copay for the first five days, followed by no copay for days six through 90. This plan also includes valuable supplemental benefits, such as dental coverage up to a $3,500 annual limit with no copay for preventive care and oral surgery. Vision care features an annual routine eye exam with a copay ranging from no copay to $35, alongside a $200 yearly allowance for eyewear. Additionally, members receive a $75 over-the-counter allowance every three months with no copay or coinsurance.
Inpatient Hospital See details
DEVOTED CORE 014 TX (HMO) offers partially covered inpatient hospital benefits with no coinsurance, requiring a $280 copay per day for days 1 through 5 and no copay for days 6 through 90 per stay. Room upgrades, non-Medicare-covered stays, and additional days for psychiatric hospitalizations are not covered.
Outpatient Services See details
DEVOTED CORE 014 TX (HMO) covers outpatient services with no coinsurance, featuring no copays for ambulatory surgical center and outpatient blood services. Outpatient hospital services have a copay of $0 to $380, observation services require a $280 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
DEVOTED CORE 014 TX (HMO) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED CORE 014 TX (HMO), with prior authorization required for all ambulance services. Ground ambulance services require no copay to a $325 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
DEVOTED CORE 014 TX (HMO) covers emergency services with a $130 copay and no coinsurance, with the copay 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, while worldwide emergency services are covered up to a $25,000 lifetime limit with a $130 copay for emergency or urgent care and a $325 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED CORE 014 TX (HMO) covers primary care physician services with no copay and no coinsurance, while specialists, therapy, mental health, psychiatric, and opioid treatment services require copays ranging from $35 to $50 with no coinsurance. Telehealth services are available with copays from $0 to $45 and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
DEVOTED CORE 014 TX (HMO) covers preventive services, annual physical exams, kidney disease education, and routine screenings with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for services like fitness programs and nutritional counseling, while sub-services such as therapeutic massage, in-home support, and personal emergency response systems are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED CORE 014 TX (HMO), which offers routine exams for a $35 copay and no coinsurance, with no deductible. Up to two prescription hearing aids are covered annually with a $399 to $699 copay and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by DEVOTED CORE 014 TX (HMO), featuring one routine eye exam per year with a $0 to $35 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Covered eyewear—including contacts, eyeglasses, frames, lenses, and upgrades—has no copay, no coinsurance, and no deductible, up to a $200 annual maximum.
Dental Services See details
Dental services are partially covered by DEVOTED CORE 014 TX (HMO) up to a $3,500 annual maximum, offering preventive care, periodontics, and oral surgery with no copay and no coinsurance. Restorative, endodontic, and prosthodontic services are covered with no copay and 0% to 50% coinsurance, while Medicare-covered dental requires a $35 copay and no coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED CORE 014 TX (HMO) with no copay, with prior authorization required. Associated Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance ranging from no coinsurance to 20%, while covered Part B insulin drugs require a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the DEVOTED CORE 014 TX (HMO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive this benefit.
Medical Equipment See details
DEVOTED CORE 014 TX (HMO) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment has a 20% to 25% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic equipment is partially covered with diabetic supplies requiring no coinsurance to 25% coinsurance while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED CORE 014 TX (HMO) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay. Diagnostic procedures and tests carry a copay of $0 to $95 with no coinsurance, while diagnostic radiological services have a copay starting at $0 and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED CORE 014 TX (HMO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the DEVOTED CORE 014 TX (HMO) plan, but require prior authorization. While some services are covered, standard cardiac, intensive cardiac, and pulmonary rehabilitation services (each with a $35 copay), along with supervised exercise therapy for PAD (with a $25 copay), are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by DEVOTED CORE 014 TX (HMO) because additional days beyond the standard Medicare-covered limit are not covered. This benefit features no coinsurance, no copay for days 1 through 20, and a $218 daily copay for days 21 through 100.
Other Services See details
DEVOTED CORE 014 TX (HMO) partially covers other services, offering no copay and no coinsurance for additional preventive services and over-the-counter (OTC) items, which feature a $75 allowance every three months. Acupuncture, meal benefits, and other select services are not covered.
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