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DEVOTED C-SNP PREMIUM 028 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 028 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 028 TX (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in El Paso and Hudspeth Counties. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED C-SNP PREMIUM 028 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 028 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 028 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 028 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 $4250.00 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 028 TX (HMO C-SNP) Medicare plan features an annual drug deductible of $615. Under this plan, Tier 6 Select Care Drugs are highly affordable, offering no copay for 1-month, 2-month, and 3-month fills at standard pharmacies and standard mail order. For Tier 1 Preferred Generic drugs, you will pay an $18 copay for a 1-month supply, while Tier 2 Generic drugs carry a $20 copay for a 1-month supply. For higher-tier prescriptions filled at standard pharmacies or standard mail order, cost-sharing transitions to coinsurance. Tier 3 Preferred Brand drugs require a 23% coinsurance, Tier 4 Non-Preferred drugs carry a 26% coinsurance, and Tier 5 Specialty Tier drugs require a 25% coinsurance for a 1-month supply. Knowing these copayment and coinsurance details can help you accurately budget your annual prescription drug costs with this plan.
Additional Benefits
The DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) plan delivers affordable healthcare coverage with no copay or coinsurance for primary care visits, home health services, and many preventive benefits. Members also enjoy valuable extras, including up to a $2,000 annual limit for dental care with no copay on many services, a $400 yearly eyewear allowance, and prescription hearing aids starting at no copay. Specialist visits and routine hearing exams are highly accessible, requiring only a $30 to $50 copay. For acute and diagnostic care, the plan offers no copay for laboratory services, outpatient X-rays, and ambulatory surgical center procedures. Emergency room visits carry a $130 copay, which is waived if you are admitted to the hospital. Inpatient hospital stays require a $300 daily copay for the first five days, followed by no copay for days six through ninety.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) with no coinsurance and a copay of $300 per day for days 1 through 5, followed by no copay for days 6 through 90. This benefit is partially covered because upgrades, psychiatric additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers outpatient services with no coinsurance, featuring no copay for ambulatory surgical center and blood services. Outpatient hospital services require a copay ranging from $0 to $525, while observation services carry a $300 copay per stay and outpatient substance abuse sessions require a $30 copay.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers ambulance services with prior authorization, featuring a copay ranging from no copay to $315 plus coinsurance for ground transport, and a 20% coinsurance plus a copay for air transport. While some transportation services are covered, trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require no copay to a $45 copay with no coinsurance, while worldwide emergency services are covered up to $25,000 with copays ranging from $130 to $315 and 20% coinsurance for transportation.
Primary Care See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical and occupational therapy, and mental health services have copays ranging from $30 to $50 and no coinsurance. Additional telehealth benefits are available with a $0 to $45 copay and no coinsurance, though chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and nutritional therapy. However, certain sub-services are not covered, including in-home safety assessments, personal emergency response systems, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, and telemonitoring.
Hearing Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) partially covers hearing services, offering routine exams for a $30 copay and no coinsurance, as well as up to two prescription hearing aids per year with no coinsurance and copays ranging from no copay to $299. OTC hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) partially covers vision services, offering one routine eye exam per year with a $0 to $20 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $400 yearly maximum allowance for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered under the DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) plan, which features a $30 copay and no coinsurance for Medicare-covered dental services, and no copay or coinsurance for other covered dental services up to a $2,000 annual limit. While many preventive and comprehensive treatments are included, other diagnostic services, other preventive services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and radiation, carry no coinsurance to 20% coinsurance, while insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment requires 20% to 35% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance up to 20% or 40% coinsurance, though diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers diagnostic and radiological services, with prior authorization required. Members pay no copay and no coinsurance for lab services, outpatient X-rays, and diagnostic radiological services, while diagnostic tests have a $0 to $95 copay with no coinsurance, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) with no coinsurance and prior authorization required, although only some services are covered. The plan does not cover cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($30 copay), and supervised exercise therapy for symptomatic peripheral artery disease services ($25 copay).
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) covers Skilled Nursing Facility (SNF) care with no coinsurance, though prior authorization is required. 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 beyond the standard Medicare limit.
Other Services See details
DEVOTED C-SNP PREMIUM 028 TX (HMO C-SNP) partially covers other services, providing no copay and no coinsurance for over-the-counter items up to $50 every three months, diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and dual-eligible highly integrated services are not covered.
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