A non-government entity
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PLUS 022 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 PLUS 022 AZ (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 PLUS 022 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 PLUS 022 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.
Key Plan Facts
Below are a few key facts and commonly-asked questions about DEVOTED C-SNP PLUS 022 AZ (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 022 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 $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:
Sign up for DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) plan features a $615.00 prescription drug deductible for its Basic Alternative drug benefit. If you qualify for Extra Help, your Part D premium can be reduced to $17.00. During the initial coverage phase, standard pharmacy and standard mail orders require a $19.00 copay for Tier 1 preferred generics, 25% coinsurance for Tier 2 and Tier 4 drugs, and 31% coinsurance for Tier 3 preferred brands. There is no copay for Tier 5 specialty drugs during the initial coverage phase. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs.
Additional Benefits
The DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) plan offers structured medical coverage designed to balance copays and coinsurance. Inpatient hospital stays require a copay of $2,230 for acute care or $2,080 for psychiatric care per stay with no coinsurance. Most outpatient and specialty services, including therapy and telehealth, feature no copays but require coinsurance ranging from 0% to 50% depending on the service. Routine healthcare benefits are well-supported, offering no copays for covered preventive services, routine eye exams, and dental care up to a $2,000 annual limit. Members also receive a $300 annual eyewear allowance, a $50 over-the-counter allowance every three months, and prescription hearing aid coverage with copays between $399 and $699. Skilled nursing facility stays are also covered with no copay for the first 20 days.
Inpatient Hospital See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) partially covers inpatient hospital benefits with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) covers outpatient services with no copays, featuring coinsurance ranging from no coinsurance to 50% for outpatient hospital and ambulatory surgical center services. Observation services require 50% coinsurance, while outpatient substance abuse and blood services are covered with 30% coinsurance and no deductibles.
Partial Hospitalization See details
Partial hospitalization benefits are covered by DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) with a 20% coinsurance and no copay. Prior authorization is required for these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) partially covers Ambulance and Transportation Services, offering ambulance coverage with no copay, alongside no coinsurance to 50% coinsurance for ground transport and 50% coinsurance for air transport. Transportation services to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with no copay and a 0% to 20% coinsurance up to a maximum of $40 per visit, and worldwide emergency services are covered up to a $25,000 maximum limit.
Primary Care See details
Primary care benefits are covered under DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP), though chiropractic services are only partially covered as routine chiropractic care is not covered. Most covered specialty services, including occupational therapy, physical therapy, and mental health, require no copay and a 30% coinsurance, while telehealth and other professional services feature no copay and a coinsurance ranging from no coinsurance to 30%.
Preventive Services See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) partially covers Preventive Services with no copay and no coinsurance for covered services like annual physicals and fitness benefits. Non-covered sub-services include in-home safety assessments, personal emergency response systems, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional tobacco cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) partially covers hearing services, excluding OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids. Covered benefits include one annual routine hearing exam at 50% coinsurance with no copay, unlimited fitting evaluations with no copay or coinsurance, and up to two prescription hearing aids per year for a $399 to $699 copay with no coinsurance.
Vision Services See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) covers vision services, including one routine eye exam every year with no copay and no coinsurance to 50% coinsurance. Eyewear is also covered with no copay, no coinsurance, and no deductible up to a combined maximum benefit of $300 per year.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP), featuring no copay and 30% coinsurance for Medicare dental services, and no copay or coinsurance for other covered dental services up to a $2,000 annual limit. Maxillofacial prosthetics, implant services, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) covers home infusion bundled services, requiring prior authorization and step therapy for certain drugs. Medicare Part B insulin drugs require a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) with a 20% coinsurance and no copay. Prior authorization is required for these services.
Medical Equipment See details
Medical equipment is partially covered by DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP), as diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment and diabetic supplies require no copay and 20% coinsurance, while prosthetic devices and medical supplies feature no copay and range from no coinsurance to 20% coinsurance.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) covers diagnostic and radiological services with no copay, though prior authorization is required. Members will pay a coinsurance of 0% to 50% for diagnostic tests, 50% for lab services, diagnostic radiology, and X-rays, and 20% for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) plan, though prior authorization is required. Specific copay and coinsurance cost-sharing details for these services are not specified in the plan benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) plan. This includes intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) with prior authorization, featuring no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coinsurance. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PLUS 022 AZ (HMO C-SNP) partially covers other services, providing a $50 allowance every three months for over-the-counter items, along with coverage for non-Medicare diabetic shoes and additional preventive services. Acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* 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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved