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DEVOTED C-SNP PLUS 027 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 027 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 027 AZ (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Rural Arizona. 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 027 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 027 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 027 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 027 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 027 AZ (HMO C-SNP) plan features a $615.00 annual prescription drug deductible, after which members enter the initial coverage phase. During this phase, you will pay a $19.00 copay for Tier 1 preferred generic drugs, 25% coinsurance for Tier 2 standard generics and Tier 4 non-preferred drugs, and 31% coinsurance for Tier 3 preferred brands. Notably, there is no copay for Tier 5 specialty tier drugs filled at standard retail pharmacies or through standard mail. Once your yearly out-of-pocket drug costs reach $2,100.00, you enter the catastrophic coverage phase and pay nothing for Medicare Part D covered drugs. Additionally, individuals who qualify for the low-income subsidy, also known as Extra Help, will pay a reduced Part D premium of $17.00. This plan provides a structured approach to managing your prescription medication expenses throughout the year.
Additional Benefits
The DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) plan offers comprehensive medical coverage with various cost-sharing structures. For inpatient hospital stays, members pay a copay of $2,230 for acute care or $2,080 for psychiatric care per stay, with no coinsurance. Outpatient services, primary care visits, and diagnostic tests feature no copays, though outpatient services and diagnostic testing require coinsurance ranging from 0% to 50% depending on the service. Specialist visits, Medicare-covered dental treatments, and dialysis require no copays and a 30% or 20% coinsurance. Supplemental benefits include a $300 annual eyewear allowance, comprehensive dental coverage up to a $2,000 yearly limit, and a $50 quarterly allowance for over-the-counter items. Routine physicals and fitness programs are available with no copay or coinsurance, helping members manage their health affordably.
Inpatient Hospital See details
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) partially covers inpatient hospital services, featuring a $2,230 copay and no coinsurance per stay for acute care, and a $2,080 copay and no coinsurance per stay for psychiatric care. Upgrades, non-Medicare-covered stays, and additional days for psychiatric care are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered under the DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) plan with no copays, featuring a coinsurance of 0% to 50% for outpatient hospital and ambulatory surgical center services. Outpatient substance abuse and blood services require a 30% coinsurance, while outpatient observation services have a 50% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) provides partial coverage for ambulance and transportation services. Ambulance services require prior authorization and have no copay, with ground transport ranging from no coinsurance to 45% coinsurance and air transport requiring 45% coinsurance, while transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) with a $115 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require no copay and a 0% to 20% coinsurance (up to $40 per visit), and worldwide emergency coverage is provided up to a $25,000 lifetime maximum.
Primary Care See details
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) offers partially covered primary care benefits, as routine chiropractic care is not covered. Under this plan, primary care physician visits require no copay or coinsurance, while specialist visits, therapies, and mental health services generally require a 30% coinsurance and no copay.
Preventive Services See details
Preventive services are partially covered by DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) with no copay or coinsurance for covered benefits like annual physicals and fitness programs. Uncovered sub-services include in-home safety assessments, personal emergency response systems, medication reconciliation, re-admission prevention, wigs, therapeutic massages, adult day health, palliative care, in-home support, caregiver support, extra smoking cessation, disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) partially covers hearing services, excluding OTC hearing aids along with inner ear, outer ear, and over the ear prescription hearing aids. Covered routine hearing exams require a 50% coinsurance and no copay, while covered prescription hearing aids require a copay between $399 and $699 and no coinsurance.
Vision Services See details
Vision services are covered by DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) with no copay and no coinsurance to 50% coinsurance for routine eye exams. There is no deductible, and the plan provides a $300 annual maximum benefit for eyewear, including contacts, eyeglasses, and upgrades.
Dental Services See details
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) partially covers dental services up to a $2,000 yearly maximum, though implant services, orthodontics, and maxillofacial prosthetics are not covered. Medicare-covered dental services require a 30% coinsurance and no copay, with prior authorization required for most comprehensive dental treatments.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) under prior authorization, featuring no copay and coinsurance ranging from no coinsurance to 20% for chemotherapy, radiation, and other Part B drugs. Medicare Part B insulin is also covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) with 20% coinsurance and no copay, though prior authorization is required.
Medical Equipment See details
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) covers medical equipment with no copays, including durable medical equipment at 20% coinsurance and prosthetics or medical supplies ranging from no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with diabetic supplies requiring 20% coinsurance and no copay, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) with no copays, though prior authorization is required. Coinsurance ranges from 0% to 50% for diagnostic tests, 50% for lab services, 45% to 50% for diagnostic radiological services, 20% for therapeutic radiological services, and 45% for outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) plan, though prior authorization is required to receive these benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) plan. In practice, none of the sub-services are covered, including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) partially covers Skilled Nursing Facility (SNF) services with prior authorization, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coinsurance. Additional days beyond the Medicare-covered limit are not covered.
Other Services See details
DEVOTED C-SNP PLUS 027 AZ (HMO C-SNP) partially covers Other Services, featuring a $50 quarterly over-the-counter (OTC) item allowance, non-Medicare diabetic shoes, and additional preventive services with no copay or coinsurance. Acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered under this plan.
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