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Devoted PRIME Arizona (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Devoted PRIME Arizona (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Devoted PRIME Arizona (HMO) in 2025, please refer to our full plan details page.
Devoted PRIME Arizona (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 4 out of 5 stars in 2025.
It's important to know that Devoted PRIME Arizona (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 PRIME Arizona (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 PRIME Arizona (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $2.60. 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 $590.00 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 $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
The Devoted PRIME Arizona (HMO) plan has a $590 deductible for prescription drugs. In the initial coverage phase, after the deductible is met, you will pay either a copay or coinsurance depending on the drug tier and pharmacy type. For example, you may pay a $5 copay for preferred generic drugs at a standard or mail-order pharmacy. For standard generic drugs, preferred brand drugs, and non-preferred drugs, you will pay 25% coinsurance at both standard and mail-order pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Devoted PRIME Arizona (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Primary care, preventive, and home health services have no copay. The plan also covers hearing, vision, and dental services, with copays for exams and maximum benefits for eyewear and dental services. Other services like ambulance, emergency, and skilled nursing facilities are covered, but may require copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $335 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $335 copay for days 1-6, and no copay for days 7-90. Additional days and non-Medicare covered stays for both are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered under the Devoted PRIME Arizona (HMO) plan. Outpatient Hospital Services have a copay between $0 and $435, and Observation Services have a copay of $335. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $40 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Devoted PRIME Arizona (HMO) plan. The plan has a $70 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Devoted PRIME Arizona (HMO) plan. Ground ambulance services have a copay between $0 and $350, while air ambulance services have a 20% coinsurance. Transportation services to a health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Devoted PRIME Arizona (HMO) with a $125 copay and no coinsurance, and if admitted to the hospital within 24 hours, the copay is waived. Urgently Needed Services have a copay between $0 and $45, with no coinsurance. Worldwide Emergency Services are also covered, with a $125 copay for Worldwide Emergency and Urgent Coverage, and a $350 copay and 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The Devoted PRIME Arizona (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a copay between $40 and $45, and physician specialist services with a $40 copay. Mental health specialty services have a $40 copay, and other health care professional services have a copay between $0 and $40. Physical therapy and speech-language pathology services have a copay between $40 and $65. Additional telehealth benefits have a copay between $0 and $40. Opioid treatment program services have a $40 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The Devoted PRIME Arizona (HMO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Some additional preventive services, such as in-home safety assessments, personal emergency response systems, and counseling services, are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $40 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $199 and $499, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $40 copay, and also cover eyewear with a combined maximum benefit of $1250 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $40 copay, and other dental services like oral exams, dental x-rays, and cleanings are covered. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered. The plan has a maximum benefit of $1250 per year for other dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Insulin has a $35 copay, and a coinsurance between 20% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Devoted PRIME Arizona (HMO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a coinsurance between 0% and 20%, and Medical Supplies with a 20% coinsurance; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
The Devoted PRIME Arizona (HMO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $95, and lab services with no copay. Radiological services include diagnostic radiological services with a copay up to $275, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Devoted PRIME Arizona (HMO) plan with no copay and no coinsurance, but require authorization. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Devoted PRIME Arizona (HMO), but none of the sub-services are covered. The plan does not specify any copay or coinsurance for the services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Devoted PRIME Arizona (HMO) plan, but require prior authorization. For days 1-20 and 61-100, there is no copay, while days 21-60 have a $200 copay.
Other Services See details
Other Services, including Acupuncture, Over-the-Counter (OTC) Items, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Other 2 includes $0 Preventive Services with no maximum plan benefit coverage amount.
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