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DEVOTED MA ONLY 020 TX (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED MA ONLY 020 TX (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED MA ONLY 020 TX (HMO) in 2026, please refer to our full plan details page.
DEVOTED MA ONLY 020 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 MA ONLY 020 TX (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED MA ONLY 020 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 MA ONLY 020 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. Additionally, this plan comes with a Part B Premium reduction of $184.70. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
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
Prescription drugs are not covered by DEVOTED MA ONLY 020 TX (HMO).
Additional Benefits
The DEVOTED MA ONLY 020 TX (HMO) plan offers affordable essential medical coverage, featuring no copay and no coinsurance for primary care visits and preventive services. For specialized care, members pay a $45 copay for specialist visits, while inpatient hospital stays require a $425 daily copay for days 1 through 4 and no copay thereafter. Emergency room services are covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes valuable supplemental benefits, such as dental coverage up to a $1,000 annual limit with no copay for preventive care and vision services with a $400 annual allowance for eyewear. Hearing exams are available for a $45 copay, and prescription hearing aids are covered with copays ranging from $599 to $899. Additionally, skilled nursing facility care has no copay for the first 20 days, and durable medical equipment is covered with no copay and a 16% coinsurance.
Inpatient Hospital See details
DEVOTED MA ONLY 020 TX (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a daily copay of $425 for days 1 through 4, followed by no copay for days 5 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED MA ONLY 020 TX (HMO) covers outpatient services with no coinsurance, featuring a $0 to $525 copay for outpatient hospital services and a $425 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
DEVOTED MA ONLY 020 TX (HMO) covers partial hospitalization services with a $70.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
DEVOTED MA ONLY 020 TX (HMO) covers ground ambulance services with a copay of $0 to $350 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. 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
Emergency services under DEVOTED MA ONLY 020 TX (HMO) are covered with a $115 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 $40 copay with no coinsurance, while worldwide emergency services are covered up to a $25,000 lifetime maximum with a $115 copay (no coinsurance) for care and a $350 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED MA ONLY 020 TX (HMO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Therapy and mental health services require copays ranging from $35 to $50 with no coinsurance, while podiatry is not covered, and chiropractic benefits cover some services but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under the DEVOTED MA ONLY 020 TX (HMO) plan, offering covered services with no copay and no coinsurance. Covered benefits include annual physical exams, kidney disease education, fitness benefits, and weight management, while sub-services like in-home support, personal emergency response systems, and therapeutic massage are not covered.
Hearing Services See details
DEVOTED MA ONLY 020 TX (HMO) covers hearing services with no deductible, including annual routine hearing exams for a $45 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $599 to $899, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED MA ONLY 020 TX (HMO), which offers one routine eye exam per year with a $0 to $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $400 annual maximum benefit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED MA ONLY 020 TX (HMO) with a $1,000 annual limit, offering preventive care with no copay and no coinsurance, and restorative services with no copay and 0% to 50% coinsurance. Medicare-covered dental services require a $45 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED MA ONLY 020 TX (HMO) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Medicare Part B insulin drugs require a $35 copay, while chemotherapy and other Part B drugs have no copay, with all covered Part B drugs carrying a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by DEVOTED MA ONLY 020 TX (HMO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED MA ONLY 020 TX (HMO) covers durable medical equipment and prosthetics with no copays, featuring a 16% coinsurance for durable medical equipment and ranging from no coinsurance to 18% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copays and up to 16% coinsurance for supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED MA ONLY 020 TX (HMO) with prior authorization required. Diagnostic services feature no coinsurance, with no copay for lab services and a $0 to $95 copay for tests, while radiological services require no copay for X-rays and a 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered by DEVOTED MA ONLY 020 TX (HMO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED MA ONLY 020 TX (HMO) does not cover cardiac rehabilitation services, as none of the sub-services, including intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy, are covered in practice.
Skilled Nursing Facility (SNF) See details
DEVOTED MA ONLY 020 TX (HMO) covers Skilled Nursing Facility (SNF) care with no coinsurance and no prior 3-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare limit are not covered.
Other Services See details
Other services under the DEVOTED MA ONLY 020 TX (HMO) plan are partially covered, offering additional preventive services not covered by Medicare with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan benefit.
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