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DEVOTED C-SNP 023 AZ (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP 023 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 023 AZ (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP 023 AZ (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 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 C-SNP 023 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 023 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 023 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 023 AZ (HMO C-SNP), 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 $395.00 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 $3000.00 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 C-SNP 023 AZ (HMO C-SNP) plan offers an Enhanced Alternative drug benefit with an annual prescription drug deductible of $395.00. After meeting this deductible, you will pay no copay for Tier 1 preferred generic drugs at standard pharmacies or through standard mail. For other tiers during the initial coverage phase, you will pay a coinsurance of 20% for Tier 2 standard generics, 43% for Tier 3 preferred brands, and 26% for Tier 4 non-preferred drugs. These initial coverage rates apply until your total yearly out-of-pocket drug costs reach $2,100.00. Once you reach this threshold, you enter the catastrophic coverage phase and will pay nothing for covered Medicare Part D drugs. If you qualify for the Low-Income Subsidy (LIS), your Part D cost is reduced to $0.00.
Additional Benefits
The DEVOTED C-SNP 023 AZ (HMO C-SNP) plan offers comprehensive medical coverage with many essential services requiring no copay and no coinsurance. For inpatient hospital stays, you will pay a $275 copay for the first several days and no copay for the remaining days, while home health services and preventive care are available with no copay and no coinsurance. Outpatient services, primary care, and specialist visits feature low to no copays with no coinsurance, making routine medical care highly affordable. This plan also includes valuable supplemental benefits, such as dental coverage up to a $3,500 annual limit with no copay for preventive dental services and vision care featuring a $300 annual eyewear allowance. Routine hearing exams are available for a $25 copay, and skilled nursing facility stays require no copay for the first 20 days. Additionally, members benefit from a $100 quarterly allowance for over-the-counter items and no copay for laboratory and outpatient X-ray services.
Inpatient Hospital See details
DEVOTED C-SNP 023 AZ (HMO C-SNP) partially covers inpatient hospital benefits with no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered. Acute care requires a $275 copay for days 1 to 7 and no copay for days 8 to 90, while psychiatric care requires a $275 copay for days 1 to 6 and no copay for days 7 to 90.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP 023 AZ (HMO C-SNP) with no coinsurance, though prior authorization is required for most services. You will pay no copay for ambulatory surgical center services, a $0 to $375 copay for outpatient hospital services, a $275 copay per stay for observation services, and a $25 copay for outpatient substance abuse sessions.
Partial Hospitalization See details
Partial hospitalization benefits are covered by DEVOTED C-SNP 023 AZ (HMO C-SNP) with a $70.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP 023 AZ (HMO C-SNP) partially covers ambulance and transportation services, as transportation to plan-approved or any health-related locations is not covered. Ground ambulance services require a copay ranging from no copay to $315 plus coinsurance, while air ambulance services require a 20% coinsurance plus a copay.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP 023 AZ (HMO C-SNP) with a $150 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed care ranges from no copay to a $45 copay with no coinsurance, while worldwide emergency services are covered up to a $25,000 limit with copays up to $315 and up to 20% coinsurance for transportation.
Primary Care See details
DEVOTED C-SNP 023 AZ (HMO C-SNP) covers primary care, specialist, and therapy services with no coinsurance and copays ranging from no copay up to $50. Prior authorization is required for most specialty services, and while some chiropractic services are covered, routine chiropractic care is not covered.
Preventive Services See details
DEVOTED C-SNP 023 AZ (HMO C-SNP) partially covers preventive services, providing Medicare-covered zero-dollar preventive services with no copay and no coinsurance. Sub-services that are not covered under this plan include In-Home Safety Assessments, Personal Emergency Response Systems (PERS), post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation sessions, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP 023 AZ (HMO C-SNP), offering routine exams for a $25 copay and no coinsurance, and up to two annual prescription hearing aids (all types) for a $199 to $499 copay and no coinsurance. Fitting and evaluation exams have no copay and no coinsurance, while OTC hearing aids and inner, outer, or over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by DEVOTED C-SNP 023 AZ (HMO C-SNP) with no deductible and no coinsurance, featuring annual routine eye exams with a copay ranging from no copay to $25. The plan also includes a $300 annual allowance for eyewear, including contacts, frames, lenses, and upgrades, with no copay or coinsurance.
Dental Services See details
DEVOTED C-SNP 023 AZ (HMO C-SNP) partially covers dental services up to a $3,500 annual maximum, though maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services require a $25 copay and no coinsurance, while preventive care is available with no copay and no coinsurance. Covered comprehensive services like restorative care and endodontics have no copay and a coinsurance of 0% to 50%.
Home Infusion bundled Services See details
DEVOTED C-SNP 023 AZ (HMO C-SNP) covers home infusion bundled services, including chemotherapy, radiation, and other Part B drugs with no copay and no coinsurance to 20% coinsurance. Medicare Part B insulin drugs are also covered under this benefit with a $35 copay and no coinsurance to 20% coinsurance, with prior authorization and step therapy required.
Dialysis Services See details
DEVOTED C-SNP 023 AZ (HMO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP 023 AZ (HMO C-SNP) partially covers medical equipment with no copay, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment requires 20% to 50% coinsurance, prosthetic devices and medical supplies range from no coinsurance to 20% coinsurance, and diabetic supplies range from no coinsurance to 50% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under DEVOTED C-SNP 023 AZ (HMO C-SNP) with prior authorization. Lab and outpatient X-ray services require no copay and no coinsurance, diagnostic tests have a copay of up to $95 with no coinsurance, diagnostic radiology has a copay of up to $300 with no coinsurance, and therapeutic radiology requires a 20% coinsurance with no copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance under the DEVOTED C-SNP 023 AZ (HMO C-SNP) plan. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED C-SNP 023 AZ (HMO C-SNP) plan. In practice, none of the sub-services are covered, including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP 023 AZ (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) care, requiring prior authorization and offering days 1 through 20 with no copay and no coinsurance, followed by a $218 daily copay and no coinsurance for days 21 through 100. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP 023 AZ (HMO C-SNP), which provides a $100 quarterly allowance for over-the-counter items, alongside coverage for diabetic shoes and additional preventive services with no copays or coinsurance. Acupuncture, meal benefits, and highly integrated dual-eligible SNP services are not covered.
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