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DEVOTED C-SNP PREMIUM 030 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 030 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 030 TX (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Houston. This plan received an overall rating of 5 out of 5 stars in 2026.
It's important to know that DEVOTED C-SNP PREMIUM 030 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 030 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 030 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 030 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 $4450.00 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 prescription drug coverage for the DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) plan includes an annual drug deductible of $615. Under standard pharmacy and standard mail-order services, Tier 6 Select Care Drugs are available with no copay for 1-month, 2-month, or 3-month supplies. For generic medications, Tier 1 Preferred Generics require an $18 copay for a 1-month supply, and Tier 2 Generics have a $20 copay for a 1-month supply. For higher-tier medications, the plan utilizes coinsurance rather than flat copays for standard pharmacy and mail-order fills. Tier 3 Preferred Brand drugs carry a 23% coinsurance, while Tier 4 Non-Preferred drugs require a 26% coinsurance. Tier 5 Specialty Tier drugs are covered at a 25% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) plan offers robust coverage with no copay and no coinsurance for primary care doctor visits, home health services, and preventive care. For inpatient hospital stays, members pay a $330 daily copay for days 1 through 5 and no copay for days 6 through 90. Outpatient services feature no coinsurance and range from no copay up to a $430 copay, while specialist visits require a $30 copay. This plan also features dental benefits with no copay or coinsurance up to a $2,000 annual maximum, as well as vision coverage with a $300 yearly allowance for eyewear and routine exams with no copay to a $30 copay. Routine hearing exams are available for a $30 copay, and prescription hearing aids are covered with copays ranging from $399 to $699. Additionally, emergency room visits require a $130 copay, which is waived if admitted, and members receive a $50 over-the-counter allowance every three months with no copay.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $330 daily copay for days 1 through 5 and no copay for days 6 through 90 per stay. Prior authorization is required, and the benefit is partially covered as upgrades, non-Medicare-covered stays, and psychiatric additional days are not covered.
Outpatient Services See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) covers outpatient services with no coinsurance, featuring a $0 to $430 copay for outpatient hospital services, a $330 copay per stay for observation services, and a $30 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) covers ground ambulance services with a copay of $0 to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Transportation services are not covered, including transportation to plan-approved or any health-related locations.
Emergency Services See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with a $130 copay (no coinsurance) for emergency or urgent care and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) provides primary care physician services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Other covered benefits, including physical therapy, telehealth, and mental health services, feature copays ranging from $0 to $50 and no coinsurance; however, chiropractic services are only partially covered, with routine and other chiropractic services not covered.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) with no copay and no coinsurance for covered services like annual physical exams, fitness benefits, and kidney disease education. Excluded sub-services that are not covered under this plan include in-home safety assessments, personal emergency response systems (PERS), post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health services, 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
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) covers hearing services, offering one routine hearing exam per year for a $30 copay and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay of $399 to $699 for up to two aids per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) offers partially covered vision services, which include one annual routine eye exam with a $0 to $30 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $300 yearly limit for contact lenses, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) partially covers dental services up to a $2,000 annual maximum, offering no copay and no coinsurance for covered preventive and comprehensive care, while Medicare-covered dental requires a $30 copay and no coinsurance. Excluded from coverage are other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) with no copay, while associated Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance of no coinsurance to 20%. Covered Part B insulin is subject to a $35 copay and no coinsurance to 20% coinsurance, with prior authorization and step therapy rules applying to these benefits.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
Medical Equipment is partially covered by DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) with no copay, though prior authorization is required for these services. Covered durable medical equipment incurs a 20% to 50% coinsurance, prosthetics and medical supplies range from no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 50% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP), with prior authorization required for all services. Diagnostic lab services feature no copay or coinsurance, diagnostic procedures range from a $0 to $95 copay with no coinsurance, and radiological services require varying copays and coinsurance, including a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) with no coinsurance and required prior authorization, though some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and carry copays of $25 to $30.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) covers Skilled Nursing Facility (SNF) services 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 while a 3-day inpatient hospital stay is not required prior to admission, additional days beyond the standard 100 days are not covered.
Other Services See details
DEVOTED C-SNP PREMIUM 030 TX (HMO C-SNP) offers partial coverage for other services, featuring 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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