Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 014 AZ (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 014 AZ (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) is a HMO C-SNP 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 C-SNP PREMIUM 014 AZ (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 014 AZ (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.
Below are a few key facts and commonly-asked questions about DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
For DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.00. 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 $4800.00 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.
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The DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) plan features a $615.00 prescription drug deductible before your initial coverage begins. Once this deductible is met, you pay for your prescription drugs based on tier-specific copays and coinsurance until your total drug costs reach $2,100.00. After meeting this limit, you enter the catastrophic coverage phase where you pay nothing for Medicare Part D covered drugs. At standard pharmacies and standard mail-order services, Tier 1 preferred generic drugs carry a $20.00 copay, while Tier 5 specialty drugs have no copay. Tier 2 standard generics and Tier 4 non-preferred drugs require a 25% coinsurance, and Tier 3 preferred brand drugs require a 47% coinsurance. Additionally, individuals who qualify for the low-income subsidy will pay a reduced Part D premium of $17.00.
The DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) plan offers robust medical coverage with affordable cost-sharing, featuring no coinsurance and no copays for primary care visits, preventive services, and lab tests. For inpatient hospital stays, members are responsible for daily copays for the first several days, while outpatient services range from no copay to a $410 copay. Emergency services are covered with a $130 copay that is waived if admitted, and urgent care options feature low to no copays. Beyond basic medical care, the plan provides valuable supplemental benefits including a $3,000 yearly dental maximum, a $300 annual eyewear allowance, and a $50 quarterly allowance for over-the-counter items. Routine eye and hearing exams are covered with low copays, though prescription hearing aids require copays ranging from $399 to $699. Please note that some services, such as routine transportation, acupuncture, and cardiac rehabilitation, are not covered by this plan.
Inpatient hospital services are covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) with no coinsurance, requiring a $310 daily copay for days 1 through 7 of acute stays (no copay for days 8 through 90) and days 1 through 6 of psychiatric stays (no copay for days 7 through 90). Prior authorization is required for these benefits, and certain sub-services such as upgrades, additional psychiatric days, and non-Medicare-covered stays are not covered.
DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) covers outpatient services with no coinsurance, including no copay for ambulatory surgical center services and outpatient blood services. Other covered services require copays, ranging from $0 to $410 for outpatient hospital services, $310 per stay for observation services, and $30 for outpatient substance abuse sessions.
Partial hospitalization benefits are covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) with a $70 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and transportation services are partially covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require a copay ranging from no copay to $350 and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
DEVOTED C-SNP PREMIUM 014 AZ (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 range from no copay to a $45 copay with no coinsurance, and worldwide emergency services are covered up to $25,000 with copays of $130 for care and a $350 copay plus 20% coinsurance for emergency transportation.
DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) covers primary care, specialist, therapy, and telehealth services with no coinsurance and copays ranging from no copay up to $65. Chiropractic services are partially covered, with routine chiropractic care excluded from coverage.
Preventive services are partially covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP), offering Medicare-covered zero-dollar preventive services and annual physicals with no copay and no coinsurance. Covered benefits include fitness programs and diabetes self-management, while services such as in-home safety assessments, personal emergency response systems, and counseling are not covered.
Hearing services are partially covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP), though OTC hearing aids and inner, outer, or over-the-ear prescription aids are not covered. Routine exams require a $30 copay and no coinsurance, while covered prescription hearing aids have a copay of $399 to $699 and no coinsurance.
Vision services are covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) with no coinsurance, featuring eye exam copays ranging from no copay to $30 and one routine exam per year. Members also receive a $300 annual allowance for eyewear, including contacts and eyeglasses, with no deductibles.
Dental services are partially covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP), requiring a $30 copay for Medicare dental services and no coinsurance to 50% coinsurance for restorative, endodontic, and prosthodontic services. These benefits feature a $3,000 annual maximum, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) covers Home Infusion bundled Services, which require prior authorization and carry no copay and no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Covered Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical equipment is partially covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) with no copays, though coinsurance ranges from no coinsurance to 50% for durable medical equipment and diabetic supplies, and up to 20% for prosthetics and medical supplies. Prior authorization is required for these services, and diabetic therapeutic shoes and inserts are not covered.
Diagnostic and radiological services are covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) with prior authorization. Under this plan, lab services and outpatient X-rays have no copay and no coinsurance, diagnostic tests require a $0 to $95 copay and no coinsurance, diagnostic radiological services require a $0 to $275 copay and no coinsurance, and therapeutic radiological services require a 20% coinsurance with no copay.
Home Health Services are covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP), though prior authorization is required to access these benefits.
Cardiac Rehabilitation Services are not covered under the DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) plan, as cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are all excluded from coverage.
Skilled Nursing Facility (SNF) care is partially covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP) with no coinsurance, but prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond Medicare-covered SNF care are not covered.
Other Services are partially covered by DEVOTED C-SNP PREMIUM 014 AZ (HMO C-SNP), which provides a $50 quarterly allowance for over-the-counter items, diabetic shoes not covered by Medicare, and additional preventive services with no copay or coinsurance. Acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered under this plan.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
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