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DEVOTED C-SNP CHOICE PREMIUM 013 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 PREMIUM 013 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 PREMIUM 013 IL (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Greater Rockford. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 013 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 PREMIUM 013 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 PREMIUM 013 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 PREMIUM 013 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 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 combined Maximum Out-Of-Pocket cost of $6500.00 (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 $6500.00 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 PREMIUM 013 IL (PPO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) plan features an annual drug deductible of $615. Under this plan, tier 6 select care drugs are highly affordable with no copay for standard pharmacy and mail-order fills. For standard generic prescriptions, you will pay an $18 copay for tier 1 preferred generics and a $19 copay for tier 2 generics on a one-month supply. Brand-name and specialty medications are subject to coinsurance rather than flat copays under standard coverage. Tier 3 preferred brands require 21% coinsurance, tier 4 non-preferred drugs require 33% coinsurance, and tier 5 specialty drugs carry a 25% coinsurance for a one-month supply. This clear pricing structure allows you to easily estimate your out-of-pocket prescription expenses.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For specialist visits, copays range from $35 to $50, while emergency room visits carry a $130 copay that is waived if you are admitted. Inpatient hospital stays require a $405 copay for the first 7 days of acute stays and the first 5 days of psychiatric stays, followed by no copay for the remaining covered days. Supplemental benefits include vision exams with copays up to $35 and eyewear covered with no copay up to a $300 annual limit, alongside dental care featuring no copay for covered services up to a $2,000 yearly maximum. Hearing exams require a $35 copay, while prescription hearing aids have copays ranging from $399 to $699. Additionally, the plan covers medical equipment with no copays and coinsurance ranging from 20% to 50%, and offers a $50 quarterly over-the-counter benefit.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Medicare-covered acute stays require a $405 copay for days 1 through 7 and no copay for days 8 through 90, while psychiatric stays require a $405 copay for days 1 through 5 and no copay for days 6 through 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers outpatient services with no coinsurance, featuring a copay of $0 to $505 for hospital services, $405 per stay for observation services, and $35 for substance abuse sessions. Ambulatory surgical center and blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers partial hospitalization services with a $60 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers ground ambulance services with a $0 to $330 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. Although transportation is technically covered, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers emergency services with a $130 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, and worldwide emergency services are covered up to $25,000 with a $130 copay and no coinsurance for medical care, or a $330 copay and 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) provides primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services feature copays ranging from $35 to $50 and no coinsurance. Chiropractic services are only partially covered with a $15 copay and no coinsurance, as routine chiropractic care is not covered.
Preventive Services See details
Preventive Services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) with no copay and no coinsurance for all covered services. While annual physical exams, fitness benefits, and nutritional therapy are covered, several sub-services such as in-home safety assessments, personal emergency response systems, and therapeutic massages are not covered.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers hearing services with no deductible, requiring prior authorization, a $35 copay, and no coinsurance for hearing exams. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399 to $699 for up to two aids per year, while OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) offers partially covered vision services with no deductibles, though other eye exam services are not covered. Covered eye exams have a copay of $0 to $35 with no coinsurance, while eyewear is covered with no copay, no coinsurance, and a $300 annual maximum benefit.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) offers partially covered dental services, featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services up to a $2,000 yearly maximum. However, other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers Home Infusion bundled Services with no copay, subject to prior authorization. Associated Medicare Part B drugs, including chemotherapy and radiation drugs, carry no copay and coinsurance ranging from no coinsurance up to 20%, while Part B insulin drugs require a $35 copay with coinsurance ranging from no coinsurance up to 20%.
Dialysis Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment requires a 20% to 50% coinsurance, while prosthetics and medical supplies range from no coinsurance to 20% coinsurance. Diabetic equipment is partially covered with no coinsurance to 50% coinsurance for diabetic supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers diagnostic and radiological services with prior authorization required. Lab services and outpatient X-rays feature no copay, diagnostic procedures and tests have a copay ranging from $0 to $95 with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered under the DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) with no copay and no coinsurance, meaning some services are covered; however, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. You will pay no copay for days 1 through 20 and a $218 copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 013 IL (PPO C-SNP) with no copay and no coinsurance, including a $50 quarterly over-the-counter (OTC) benefit, diabetic shoes, and additional preventive services. Acupuncture and meal benefits are not covered under this plan.
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