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DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PLUS 012 IL (PPO 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 CHOICE PLUS 012 IL (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Downstate Illinois. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PLUS 012 IL (PPO 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 CHOICE PLUS 012 IL (PPO 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 CHOICE PLUS 012 IL (PPO 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 CHOICE PLUS 012 IL (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $15.20. 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 has a $890.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 combined Maximum Out-Of-Pocket cost of $13900.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13900.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 CHOICE PLUS 012 IL (PPO C-SNP)
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Drug Coverage
The DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) prescription drug plan features an annual drug deductible of $615. For Tier 6 Select Care Drugs, members benefit from no copay for one-month, two-month, or three-month fills at standard pharmacies and standard mail order. Standard pharmacy and mail order copays for Tier 1 Preferred Generic drugs are $18 for a one-month supply, while Tier 2 Generic drugs cost $19 for a one-month supply. Brand-name and specialty medications are covered under coinsurance, with Tier 3 Preferred Brand drugs requiring a 25% coinsurance and Tier 4 Non-Preferred drugs requiring a 31% coinsurance. Tier 5 Specialty Tier drugs require a 25% coinsurance for a one-month supply through standard pharmacy or standard mail order options. These cost-sharing structures help you plan your healthcare expenses when choosing this Medicare Advantage plan.
Additional Benefits
The DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care, preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance but will have a copay of $2,230 per stay for acute care and $2,080 per stay for psychiatric care. Specialist visits, outpatient hospital care, and diagnostic services feature no copays, though coinsurance rates apply, ranging from 20% to 50% depending on the specific service. Additional benefits include dental coverage up to a $3,500 annual limit and eyewear coverage up to a $300 annual maximum, both with no copays or coinsurance. Hearing aids are covered with no coinsurance and copays ranging from $399 to $699, while routine hearing and vision exams require no copay but up to 50% coinsurance. Members also benefit from a $50 quarterly over-the-counter allowance and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) with no coinsurance, requiring a $2,230 copayment per stay for acute care and a $2,080 copayment per stay for psychiatric care. While unlimited additional days are covered for acute care, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) with no copays, though prior authorization is required for most care. Under this plan, you will pay no coinsurance to 50% coinsurance for outpatient hospital and ambulatory surgical center services, and 30% coinsurance for outpatient substance abuse and blood services.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) covers partial hospitalization services with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) with no copay and a coinsurance of 0% to 45% for ground transport and 45% for air transport, subject to prior authorization. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO 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 have no copay and a 0% to 20% coinsurance up to $40 per visit, while worldwide emergency services are covered up to $25,000 with no copay or coinsurance.
Primary Care See details
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialist, therapy, psychiatric, and mental health services require no copay and 30% coinsurance. For chiropractic care, some services are covered but routine chiropractic care and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by the DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) plan with no copay and no coinsurance for covered care such as annual physicals, kidney disease education, and fitness benefits. However, several services are not covered, including 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 smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, and counseling services.
Hearing Services See details
Hearing services are covered by DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) with no deductible, offering hearing exams for no copay with a 50% coinsurance for routine exams, and prescription hearing aids with no coinsurance and a $399 to $699 copay. This benefit is partially covered, as OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) provides partially covered vision services, as other eye exam services are not covered. Routine eye exams are covered with no copay and 0% to 50% coinsurance, while eyewear is covered with no copay and no coinsurance up to a $300 annual maximum benefit for contacts, eyeglasses, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) partially covers dental services, offering Medicare-covered dental with no copay and 30% coinsurance, and other covered dental services with no copay and no coinsurance up to a $3,500 annual maximum. Other diagnostic services, other preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) with no copay and no coinsurance, though prior authorization is required. Associated Part B chemotherapy and other drugs require no coinsurance to 20% coinsurance, while insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required before receiving these services.
Medical Equipment See details
Medical equipment benefits are partially covered by DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) with no copay required for covered items, though prior authorization is necessary. Durable medical equipment and diabetic supplies require a 20% coinsurance, while prosthetic devices and medical supplies range from no coinsurance to 20% coinsurance; diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under the DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) plan with prior authorization required and no copays. There is no coinsurance for diagnostic procedures and tests, but members will pay a 20% coinsurance for therapeutic radiological services and a 50% coinsurance for lab, diagnostic radiological, and outpatient X-ray services.
Home Health Services See details
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) covers Home Health Services with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) covers cardiac rehabilitation services with no copay and prior authorization required; however, while some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior 3-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other services are partially covered under the DEVOTED C-SNP CHOICE PLUS 012 IL (PPO C-SNP) plan, while acupuncture and meal benefits are not covered. Covered benefits, including over-the-counter items up to $50 every three months, non-Medicare covered diabetic shoes, and additional preventive services, are offered with no copay and no coinsurance.
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