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DEVOTED CORE 016 AZ (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED CORE 016 AZ (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on DEVOTED CORE 016 AZ (HMO) in 2026, please refer to our full plan details page.
DEVOTED CORE 016 AZ (HMO) is a HMO plan offered by Devoted Health, Inc. available for enrollment in 2025 to people living in Pima County. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED CORE 016 AZ (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED CORE 016 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 CORE 016 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.
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 $305.00 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 $2700.00 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 CORE 016 AZ (HMO) Medicare plan features an Enhanced Alternative drug benefit with a $305.00 annual prescription drug deductible. After meeting this deductible, you will pay a $5.00 copay for Tier 1 preferred generic drugs at standard pharmacies and standard mail order. For other tiers, you will pay 24% coinsurance for Tier 2 standard generics, 25% coinsurance for Tier 3 preferred brands, and 29% coinsurance for Tier 4 non-preferred drugs. Once your yearly out-of-pocket drug costs reach $2,100.00, you will transition to the catastrophic coverage phase. During this phase, you will have no copay and pay nothing for covered Medicare Part D prescription drugs. Additionally, individuals who qualify for the low-income subsidy can reduce their Part D premium to $0.00.
Additional Benefits
The DEVOTED CORE 016 AZ (HMO) plan provides comprehensive medical coverage, featuring inpatient hospital stays with a $225 daily copay for days 1 through 7 and no copay for days 8 through 90. Outpatient hospital services range from no copay to a $325 copay, while primary care visits require no copay to a $50 copay. Emergency care carries a $150 copay, which is waived if you are admitted to the hospital within 24 hours. Beyond basic medical care, the plan offers generous supplemental benefits including dental coverage up to a $3,000 annual maximum with no copay and up to 50% coinsurance for covered services. Vision benefits feature a $200 annual eyewear allowance with no copay, and hearing care includes prescription hearing aids for copays between $399 and $699. Members also benefit from a $75 over-the-counter item allowance every three months with no copay or coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED CORE 016 AZ (HMO) with a $225 copay per day for days 1 through 7, no copay for days 8 through 90, and no coinsurance, though prior authorization is required. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED CORE 016 AZ (HMO) with no coinsurance, featuring no copay for ambulatory surgical center services and copays ranging from $0 to $325 for outpatient hospital services. The plan also requires a $225 copay per stay for observation services and a $35 copay per session for outpatient substance abuse services, with prior authorization required for most care.
Partial Hospitalization See details
DEVOTED CORE 016 AZ (HMO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization is required to access these benefits.
Ambulance and Transportation Services See details
DEVOTED CORE 016 AZ (HMO) partially covers Ambulance and Transportation Services, as transportation services to health-related locations are not covered. Covered ground ambulance services require no copay to a $325 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
DEVOTED CORE 016 AZ (HMO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay to a $45 copay and no coinsurance, while worldwide emergency services are covered up to $25,000 with copays ranging from $150 to $325 and up to 20% coinsurance.
Primary Care See details
Primary Care benefits are partially covered by DEVOTED CORE 016 AZ (HMO) with no coinsurance and copays ranging from no copay up to $50.00 for covered services. While most specialist, therapy, and telehealth services are included, podiatry services and routine chiropractic care are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED CORE 016 AZ (HMO), featuring Medicare-covered zero-dollar services with no copay and no coinsurance, as well as annual physical exams. Additional preventive benefits are partially covered, including fitness and weight management programs, while services like in-home support, caregiver support, and personal emergency response systems are not covered. Glaucoma screenings and diabetes self-management training are also covered with no referral required.
Hearing Services See details
DEVOTED CORE 016 AZ (HMO) partially covers hearing services, offering routine hearing exams for a $35 copay and no coinsurance, alongside fitting evaluations and up to two prescription hearing aids per year with a copay between $399 and $699 and no coinsurance. 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 CORE 016 AZ (HMO), featuring a $0 to $35 copay and no coinsurance for eye exams, which includes one routine exam per year. The plan also provides a $200 annual allowance for eyewear, including contacts and eyeglasses, with no copay, no coinsurance, and no deductible.
Dental Services See details
DEVOTED CORE 016 AZ (HMO) partially covers dental services up to a $3,000 annual maximum, excluding maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services require a $35 copay and no coinsurance, while other covered services have no copay and coinsurance ranging from 0% to 50%.
Home Infusion bundled Services See details
Home infusion bundled services are covered under DEVOTED CORE 016 AZ (HMO) with prior authorization, requiring no copay and coinsurance ranging from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Covered Medicare Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
DEVOTED CORE 016 AZ (HMO) covers dialysis services with 20% coinsurance and no copay. Prior authorization is required for this benefit.
Medical Equipment See details
DEVOTED CORE 016 AZ (HMO) partially covers medical equipment with no copays, featuring 20% to 50% coinsurance for durable medical equipment, no coinsurance to 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 50% coinsurance for diabetic supplies. Diabetic therapeutic shoes and inserts are not covered, and prior authorization is required for covered equipment.
Diagnostic and Radiological Services See details
DEVOTED CORE 016 AZ (HMO) covers diagnostic and radiological services with prior authorization, including lab services and outpatient X-rays with no copay and no coinsurance. Diagnostic procedures and tests range from no copay to a $95 copay, diagnostic radiology ranges from no copay to a $275 copay, and therapeutic radiology requires 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED CORE 016 AZ (HMO) plan, though prior authorization is required to receive these benefits. Specific copay and coinsurance cost details are not specified for this service.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED CORE 016 AZ (HMO) plan, including intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
DEVOTED CORE 016 AZ (HMO) partially covers Skilled Nursing Facility (SNF) services with prior authorization, requiring no copay or coinsurance for days 1 through 20, and a $218 daily copay with no coinsurance for days 21 through 100. Additional days beyond the Medicare-covered limit are not covered, though a prior 3-day inpatient hospital stay is not required for admission.
Other Services See details
Other Services are partially covered by DEVOTED CORE 016 AZ (HMO), featuring a $75 over-the-counter (OTC) item allowance every three months with no copay or coinsurance, as well as coverage for additional preventive services. Acupuncture, meal benefits, and dual eligible SNP services are not covered under this plan.
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