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DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PREMIUM 024 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 024 AZ (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PREMIUM 024 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 PREMIUM 024 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 024 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 PREMIUM 024 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 PREMIUM 024 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 $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 PREMIUM 024 AZ (HMO C-SNP) plan features a $615.00 prescription drug deductible before your initial coverage begins. Under this plan, standard pharmacy and standard mail orders require a $20.00 copay for Tier 1 preferred generics, while Tier 5 specialty drugs have no copay. Other drug tiers require coinsurance, ranging from 23% for standard generics to 26% for preferred brand drugs. These cost-sharing rates apply until your total out-of-pocket drug expenses reach $2,100.00, after which you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. Additionally, individuals who qualify for Extra Help or the Low-Income Subsidy will pay a reduced Part D premium of $17.00. Please review the plan's formulary to confirm the specific tier and coverage details for your prescriptions.
Additional Benefits
The DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) plan offers comprehensive medical coverage featuring no copay to a $50 copay for primary care, and specialist visits ranging from no copay to $45. Inpatient hospital stays require a $305 copay for the first seven days with no copay thereafter, while emergency room visits incur a $150 copay. Outpatient surgical services and diagnostic lab tests are highly affordable, with many key services requiring no copay and no coinsurance. For extra health services, members receive up to $2,000 annually for dental care with no copay, alongside a $300 annual eyewear allowance with no copay or deductible. Routine hearing exams require a $30 copay, and prescription hearing aids are covered with copays between $399 and $699. Additionally, the plan provides a $50 allowance every three months for over-the-counter items and covers preventive benefits like fitness programs with no copay.
Inpatient Hospital See details
DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) partially covers inpatient hospital benefits with no coinsurance, featuring a $305 copay for days 1 to 7 of acute stays (no copay for days 8 to 90) and a $305 copay for days 1 to 6 of psychiatric stays (no copay for days 7 to 90). Non-Medicare-covered stays, acute care upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) with no coinsurance, featuring no copay for ambulatory surgical center services and a $30 copay for outpatient substance abuse sessions. Outpatient hospital services require a copay of $0 to $405, and observation services incur a $305 copay per stay.
Partial Hospitalization See details
DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) covers partial hospitalization benefits with a $70 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP), as transportation services to plan-approved or any health-related locations are not covered. Ground ambulance services require a copay of no copay to $315 with no coinsurance, while air ambulance services require a 20% coinsurance with no copay.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) with a $150 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, while worldwide emergency services are covered up to $25,000 with copays up to $315 and coinsurance up to 20%.
Primary Care See details
Primary Care benefits are covered by DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) with copays ranging from no copay up to $50 and no coinsurance, though chiropractic services are only partially covered because routine chiropractic care is not covered. Covered services include specialist visits, physical and occupational therapy, psychiatric care, and telehealth benefits, which feature copays ranging from no copay up to $45 and no coinsurance.
Preventive Services See details
DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and health education. However, several sub-services are not covered, including in-home safety assessments, personal emergency response systems (PERS), post-discharge medication reconciliation, readmission prevention, wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
Hearing services are covered by DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP), featuring routine hearing exams with a $30 copay and no coinsurance. Prescription hearing aids are partially covered with a copay between $399 and $699 and no coinsurance for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) covers vision services, including annual routine eye exams with a copay of $0 to $30 and no coinsurance. Members also receive a $300 annual allowance for eyewear, including lenses, frames, and contacts, with no copay, no deductible, and no coinsurance.
Dental Services See details
DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) covers Medicare dental services with a $30 copay and no coinsurance, as well as other dental services up to $2,000 per year with no copay or coinsurance. Orthodontic services are partially covered, with maxillofacial prosthetics, implant services, and orthodontics excluded from coverage.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) with prior authorization, requiring 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.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Medical Equipment See details
Medical Equipment is partially covered by DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP), though diabetic therapeutic shoes and inserts are not covered. Covered items like durable medical equipment, prosthetics, and diabetic supplies require prior authorization and feature no copay, with coinsurance ranging from no coinsurance up to 50%.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) covers diagnostic and radiological services with prior authorization, offering no copay for lab services and outpatient X-rays. Diagnostic procedures and tests have a copay ranging from $0 to $95, diagnostic radiological services range from a $0 to $300 copay, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) covers Home Health Services, though prior authorization is required before receiving care. Specific copay and coinsurance costs for these covered services are not specified in the plan benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) plan. This lack of coverage applies to all related sub-services—including intensive cardiac, pulmonary, and supervised exercise therapy—meaning there are no plan-covered copays or coinsurance options available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP), requiring prior authorization and excluding additional days beyond the Medicare-covered limit. There is no copay or coinsurance for days 1 through 20, followed by a $218 daily copay and no coinsurance for days 21 through 100.
Other Services See details
DEVOTED C-SNP PREMIUM 024 AZ (HMO C-SNP) offers partial coverage for other services, featuring a $50 benefit every three months for over-the-counter (OTC) items, as well as coverage for non-Medicare diabetic shoes and additional preventive services. Acupuncture, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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