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DEVOTED C-SNP PLUS 033 TX (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PLUS 033 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 PLUS 033 TX (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP PLUS 033 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 PLUS 033 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 PLUS 033 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 PLUS 033 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 $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
The DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) plan features an annual drug deductible of $615 before coverage begins. For standard pharmacy and mail-order prescriptions, Tier 1 preferred generics carry an $18 copay for a one-month supply, while Tier 2 generics cost $19. Tier 6 select care drugs are highly affordable, offering no copay for one, two, or three-month supplies. For higher-tier medications, standard cost-sharing transitions to a coinsurance model. Standard fills for Tier 3 preferred brands and Tier 5 specialty drugs require 25% coinsurance, whereas Tier 4 non-preferred drugs carry a 31% coinsurance. These standard options provide predictable cost-sharing structures for your prescription needs.
Additional Benefits
The DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits and home health services. For hospital stays, members pay a copay of $2,230 per acute inpatient admission and $2,080 per psychiatric admission, with no coinsurance required. Outpatient services, diagnostic tests, and emergency care are also covered, with emergency visits requiring a $115 copay that is waived upon admission. This plan also provides robust supplemental benefits, including preventive and comprehensive dental care with no copay and no coinsurance up to a $3,000 annual limit. Routine vision and hearing exams feature no copays but may require coinsurance, while members can also access a $300 annual eyewear allowance and prescription hearing aids with copays ranging from $399 to $699. Additionally, skilled nursing facility stays require no copay for the first 20 days, and members receive a $50 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) partially covers inpatient hospital services, with acute stays requiring a $2,230 copay per admission and psychiatric stays requiring a $2,080 copay per admission, both with no coinsurance. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) with no copays, though coinsurance and prior authorization requirements apply. Outpatient hospital and ambulatory surgical center services feature no copay and range from no coinsurance to 50% coinsurance, while outpatient substance abuse and blood services require no copay and 30% coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) covers ambulance services with prior authorization, offering no copay and a coinsurance ranging from no coinsurance to 40% for ground transport and a 40% coinsurance for air transport. Routine transportation services to health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay and a 0% to 20% coinsurance of up to $40 per visit, while worldwide emergency services are covered up to a $25,000 limit with no copay and no coinsurance.
Primary Care See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) covers primary care physician services with no copay and no coinsurance, though chiropractic services are not covered. Other covered services—including specialists, therapy, mental health, and telehealth—require no copay and a coinsurance ranging from 0% to 30%.
Preventive Services See details
Preventive Services are partially covered by DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) with no copay and no coinsurance for covered care, including annual physicals, fitness benefits, and nutritional therapy. However, several sub-services are not covered, such as 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, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP PLUS 033 TX (HMO C-SNP), featuring routine hearing exams with no copay and 50% coinsurance, and up to two annual prescription hearing aids with no coinsurance and a $399 to $699 copay. OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) provides partially covered vision services, as other eye exam services are not covered. Routine eye exams are covered once annually with no copay and 0% to 50% coinsurance, and eyewear is covered with no copay and no coinsurance up to a $300 yearly limit for contacts, lenses, frames, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) with no copay and no coinsurance for preventive and comprehensive care up to a $3,000 annual maximum, while Medicare-covered dental requires no copay and a 30% coinsurance. Specific services not covered under this plan include 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 PLUS 033 TX (HMO C-SNP) with no copay, though prior authorization is required. Part B chemotherapy, radiation, and other drugs carry no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment (DME) and diabetic supplies require a 20% coinsurance, while prosthetic devices and medical supplies range from no coinsurance to 20% coinsurance. Diabetic equipment is partially covered under this plan, as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required. Diagnostic procedures and tests have no coinsurance, while lab services carry a 50% coinsurance, therapeutic radiological services require a 20% coinsurance, and both diagnostic radiological and outpatient X-ray services require a 40% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) covers Cardiac Rehabilitation Services with no copay, though prior authorization is required. A 30% coinsurance applies to specific services, including standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PLUS 033 TX (HMO C-SNP) offers partially covered other services, providing 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, meal benefits, and highly integrated dual-eligible SNP services are not covered under this plan.
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