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DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP PREMIUM 023 TX (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
DEVOTED C-SNP PREMIUM 023 TX (HMO C-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 C-SNP PREMIUM 023 TX (HMO C-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 C-SNP PREMIUM 023 TX (HMO C-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 $6200.00 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 C-SNP PREMIUM 023 TX (HMO C-SNP) plan has an annual prescription drug deductible of $615. For those looking to save, Tier 6 select care drugs are available with no copay for one, two, or three-month supplies at standard pharmacies and through standard mail order. Tier 1 preferred generics and Tier 2 generics are also highly affordable, starting at an $18 copay and $20 copay respectively for a one-month supply at standard pharmacies. For brand-name and specialty medications, the plan transitions to coinsurance rather than flat copays. Standard pharmacy and mail order fills for Tier 3 preferred brands require 23% coinsurance, while Tier 4 non-preferred drugs require 26% coinsurance. Tier 5 specialty drugs are covered at 25% coinsurance for a one-month supply, helping you manage your specialized healthcare needs.
Additional Benefits
The DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care doctor visits and routine preventive services. For specialist visits, members pay a $45 copay, while inpatient hospital stays require a $460 daily copay for the first five days and no copay for remaining days. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also provides valuable extra benefits, including routine dental care with no copay up to a $2,000 annual limit and routine vision exams with no copay to a $45 copay. Additionally, members receive a $300 annual eyewear allowance and a $50 quarterly allowance for over-the-counter items with no copay. Home health services and diagnostic lab tests are also fully covered with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital care is covered by DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) with no coinsurance, requiring a $460 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $560 copay for outpatient hospital services and a $460 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 sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) with a $55.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP), featuring ground ambulance services with no coinsurance and a copay ranging from no copay to $315, and air ambulance services with no copay and a 20% coinsurance. Prior authorization is required for ambulance services, while transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) with a $130 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services carry a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 limit with a $130 copay and no coinsurance, except for emergency transportation which requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $45 copay and no coinsurance. Additional benefits like physical and occupational therapy have copays ranging from $45 to $50 with no coinsurance, while some chiropractic services are covered but routine and other chiropractic care are not.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and fitness programs. However, the plan does not cover several sub-services, including in-home safety assessments, personal emergency response systems (PERS), post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP), featuring a $45 copay and no coinsurance for one routine hearing exam per year and unlimited fitting evaluations. Up to two prescription hearing aids are covered annually with a copay ranging from $399 to $699 and no coinsurance, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) offers partially covered vision services, as other eye exam services are not covered. Covered routine eye exams cost a $0 to $45 copay with no coinsurance once per year, while eyewear is covered with no copay, no coinsurance, and no deductible up to a $300 annual limit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) offers partially covered dental services with a $45 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered dental services up to a $2,000 annual maximum. Excluded sub-services that are not covered include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) partially covers medical equipment with no copays and prior authorization requirements. Durable medical equipment requires 20% to 50% coinsurance, while covered prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 50% coinsurance, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) covers diagnostic and radiological services, with prior authorization required for these benefits. Lab services, diagnostic radiological services, and outpatient X-rays have no copay, diagnostic procedures and tests have a copay ranging from $0 to $95 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization required, although only some services are covered. Specifically, Cardiac Rehabilitation (with a $40 copay), Intensive Cardiac Rehabilitation (with a $40 copay), Pulmonary Rehabilitation (with a $35 copay), and Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease services (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and though a prior three-day hospital stay is not necessary, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 023 TX (HMO C-SNP) partially covers other services with no copay and no coinsurance for over-the-counter (OTC) items up to $50 every three months, non-Medicare covered diabetic shoes, and additional preventive services. Acupuncture and meal benefits are not covered under this plan.
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