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DEVOTED MA ONLY 005 AZ (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED MA ONLY 005 AZ (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 005 AZ (HMO) in 2026, please refer to our full plan details page.
DEVOTED MA ONLY 005 AZ (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Maricopa and Pinal Counties. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED MA ONLY 005 AZ (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 005 AZ (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 005 AZ (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 $140.00. 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 $5900.00 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 005 AZ (HMO).
Additional Benefits
The DEVOTED MA ONLY 005 AZ (HMO) plan offers comprehensive coverage for core medical needs, featuring a range of no copay to $50 for primary care visits and no copay for ambulatory surgical services. Inpatient hospital stays require a $425 daily copay for the first four days followed by no copay for days five through 90, while emergency room visits carry a $130 copay. Additionally, diagnostic labs and outpatient X-rays are available with no copay or coinsurance. For routine care, the plan provides preventive services and annual eye exams with no copay, alongside a $400 annual eyewear allowance. Covered dental services feature no copay with up to 50% coinsurance up to a $1,000 annual maximum, while prescription hearing aids are covered with a $599 to $899 copay. Skilled nursing facility stays are also covered with no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
DEVOTED MA ONLY 005 AZ (HMO) partially covers inpatient hospital services, which require a $425 daily copay for days 1 through 4 and no copay for days 5 through 90, with no coinsurance. Unlimited additional acute care days are covered, but upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED MA ONLY 005 AZ (HMO) with no coinsurance, featuring no copay for ambulatory surgical center services and a $45 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay ranging from $0 to $525, while observation services carry a $425 copay per stay.
Partial Hospitalization See details
DEVOTED MA ONLY 005 AZ (HMO) covers partial hospitalization benefits with a $70.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by DEVOTED MA ONLY 005 AZ (HMO), as transportation services to health-related locations are not covered. Covered ground ambulance services require no copay to a $350 copay with no coinsurance, while air ambulance services require a 20% coinsurance with no copay.
Emergency Services See details
Emergency services are covered by DEVOTED MA ONLY 005 AZ (HMO) with a $130 copay and no coinsurance, while urgently needed services require a copay ranging from no copay to $45 and no coinsurance. Worldwide emergency services are also covered up to a $25,000 maximum, with a $130 copay for emergency or urgent care and a $350 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
Primary care benefits are partially covered by DEVOTED MA ONLY 005 AZ (HMO), featuring copays ranging from no copay up to $50 and no coinsurance for covered services. Specialist visits, mental health services, and physical therapy are covered, but podiatry and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED MA ONLY 005 AZ (HMO) with no copay and no coinsurance for Medicare-covered zero-dollar services. Additional preventive benefits are only partially covered; covered services include fitness and weight management, while excluded services are in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
DEVOTED MA ONLY 005 AZ (HMO) partially covers hearing services, offering routine hearing exams for a $45 copay and fitting evaluations with no copay, both with no coinsurance. Prescription hearing aids are covered up to two per year with a $599 to $899 copay and no coinsurance, though OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are covered by DEVOTED MA ONLY 005 AZ (HMO), featuring eye exams with no deductible, no coinsurance, and copays ranging from no copay for an annual routine exam up to $45. The plan also covers eyewear with a $400 annual maximum allowance, requiring no copay, no coinsurance, and no deductible.
Dental Services See details
Dental services are partially covered by DEVOTED MA ONLY 005 AZ (HMO), excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $45 copay and no coinsurance, while other covered dental services feature no copay and 0% to 50% coinsurance up to a $1,000 annual maximum.
Home Infusion bundled Services See details
Home infusion bundled services are partially covered by DEVOTED MA ONLY 005 AZ (HMO) with prior authorization required, as Part D home infusion drugs are not covered. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and a 0% to 20% coinsurance, while Medicare Part B insulin drugs carry a $35 copay and a 0% to 20% coinsurance.
Dialysis Services See details
DEVOTED MA ONLY 005 AZ (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED MA ONLY 005 AZ (HMO), though diabetic therapeutic shoes and inserts are not covered. Covered items require no copay, with coinsurance ranging from 20% to 50% for durable medical equipment, no coinsurance to 20% for prosthetics and medical supplies, and no coinsurance to 50% for diabetic supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED MA ONLY 005 AZ (HMO) with prior authorization, featuring no copay or coinsurance for lab and outpatient X-ray services. Diagnostic procedures require a copay of $0 to $95, diagnostic radiological services cost up to a $300 copay (both with no coinsurance), and therapeutic radiological services require 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered under the DEVOTED MA ONLY 005 AZ (HMO) plan, with prior authorization required to access these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED MA ONLY 005 AZ (HMO) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation sub-services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
DEVOTED MA ONLY 005 AZ (HMO) partially covers Skilled Nursing Facility (SNF) benefits with prior authorization, featuring no copay and no coinsurance for days 1 through 20, and a $218 daily copay and no coinsurance for days 21 through 100. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED MA ONLY 005 AZ (HMO) partially covers Other Services, providing coverage for additional preventive services not covered by Medicare with no maximum benefit limit, though specific copay and coinsurance details are not specified. Sub-services such as acupuncture, over-the-counter (OTC) items, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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