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DEVOTED C-SNP PLUS 025 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 025 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 025 AZ (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PLUS 025 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 PLUS 025 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 025 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 025 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 025 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:
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Drug Coverage
The DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) Medicare plan features a prescription drug deductible of $615.00. After meeting this deductible, you will pay a $19.00 copay for Tier 1 preferred generic drugs at standard retail or mail-order pharmacies. Other tiers require a 25% coinsurance for Tier 2 standard generics and Tier 4 non-preferred drugs, 31% coinsurance for Tier 3 preferred brands, and no copay for Tier 5 specialty drugs. These cost-sharing rates apply during the initial coverage phase until total drug costs reach $2,100.00. Once you reach this limit, you enter the catastrophic coverage phase and will pay nothing for covered Part D drugs. Individuals who qualify for the low-income subsidy may also see their premium reduced to $17.00.
Additional Benefits
The DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) plan offers comprehensive medical coverage, including emergency care with a $115 copay and no copay for urgent care visits. Inpatient hospital stays require a flat copay of $2,230 for acute care and $2,080 for psychiatric care with no coinsurance, while outpatient services and diagnostic tests feature no copays but carry varying coinsurance up to 50%. Primary care and specialist visits are covered, with services like physical therapy requiring a 30% coinsurance. For everyday wellness, the plan provides robust dental coverage up to $3,500 annually with no copay or coinsurance, alongside vision benefits that include one no-copay routine exam per year and a $300 annual eyewear allowance. Hearing care features no-copay exams and prescription hearing aids starting at a $399 copay with no coinsurance. Additionally, members receive a $50 allowance every three months for over-the-counter items, though routine transportation and cardiac rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP), with acute care requiring a $2,230 copay per stay and no coinsurance, and psychiatric care requiring a $2,080 copay per stay and no coinsurance. Prior authorization is required, and non-Medicare-covered stays, hospital upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) with no copays, though coinsurance ranges from 0% to 50% for outpatient hospital and ambulatory surgical center services. Outpatient blood services and substance abuse sessions are also covered with no copay and a flat 30% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) with a 20% coinsurance and no copay. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) partially covers Ambulance and Transportation Services, as ambulance services are covered while transportation services to health-related locations are not covered. Covered ambulance services require prior authorization and have no copay, with coinsurance ranging from no coinsurance to 50% for ground transport and a 50% coinsurance for air transport.
Emergency Services See details
DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) covers emergency services with a $115 copay and no coinsurance, which is 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 $40 maximum per visit), while worldwide emergency, urgent, and transportation services are covered up to a $25,000 maximum benefit limit.
Primary Care See details
DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) covers primary care benefits, with most services—including occupational therapy, specialist visits, and physical therapy—requiring a 30% coinsurance. Chiropractic services are partially covered with a $15 copay, as routine chiropractic care is not covered, while other health professional and telehealth services range from no coinsurance to 30% coinsurance.
Preventive Services See details
Preventive services are partially covered under DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) with no copay and no coinsurance for Medicare-covered zero-dollar preventive benefits. Sub-services that are not covered include In-Home Safety Assessments, Personal Emergency Response Systems (PERS), post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) partially covers hearing services, providing routine exams and fitting evaluations with no copay and up to 50% coinsurance. Covered prescription hearing aids (all types) require a copay of $399 to $699 and no coinsurance, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are covered by DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP), offering one routine eye exam per year with no copay and no coinsurance to 50% coinsurance. Eyewear, including contacts and glasses, is also covered with no copay or coinsurance up to a combined maximum of $300 per year.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP), which offers up to $3,500 in annual coverage with no copay or coinsurance for preventive and comprehensive care, but excludes maxillofacial prosthetics, implant services, and orthodontics. Medicare-covered dental services are subject to a 30% coinsurance and no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are partially covered by DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) with prior authorization, as Part D home infusion drugs are not included in the bundle. Covered Part B chemotherapy and other Part B drugs require no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) with a 20% coinsurance and no copay. Prior authorization is required to receive these services.
Medical Equipment See details
Medical equipment is covered under the DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) plan, featuring no copay and 20% coinsurance for durable medical equipment, and no copay with coinsurance ranging from no coinsurance to 20% for prosthetic devices and medical supplies. Diabetic equipment is partially covered, requiring no copay and a 20% coinsurance for diabetic supplies, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required. Depending on the service, coinsurance ranges from no coinsurance up to 50%, including 50% for lab and outpatient X-ray services, and 20% for therapeutic radiological services.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) plan, subject to prior authorization requirements. Specific copay and coinsurance costs are not specified for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) plan, which does not provide coverage for cardiac, intensive cardiac, pulmonary, or supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are partially covered by DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP) with no coinsurance, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, but additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP PLUS 025 AZ (HMO C-SNP), which includes a $50 allowance every three months for over-the-counter items, non-Medicare diabetic shoes, and additional preventive services. However, acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered.
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