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DEVOTED C-SNP CHOICE PREMIUM 014 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 014 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 014 IL (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Metro East. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 014 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 014 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 014 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 014 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 $6300.00 (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 $6300.00 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 014 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 014 IL (PPO C-SNP) Medicare plan features an annual drug deductible of $615. Under this plan, Tier 6 select care drugs are available with no copay for standard pharmacy and mail-order fills. For Tier 1 preferred generics, you will pay an $18 copay for a 1-month supply, while Tier 2 generics require a $19 copay. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 21% coinsurance, and Tier 4 non-preferred drugs carry a 33% coinsurance. Specialty drugs in Tier 5 require a 25% coinsurance for a 1-month supply through standard pharmacies or standard mail order.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, or home health care. For inpatient hospital stays, members pay a $380 daily copay for days 1 through 5 and no copay for days 6 through 90. Specialist visits require a $40 to $50 copay, while emergency services have a $150 copay that is waived upon hospital admission. Additional benefits include dental coverage with up to a $2,000 annual maximum and no copay for most services. Vision benefits provide a routine exam and up to $300 annually for eyewear with no copay or deductible, while over-the-counter items feature a $50 quarterly allowance. Hearing care is also supported, with routine exams requiring a $40 copay and prescription hearing aids covered with a $399 to $699 copay.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $380 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) with no coinsurance, featuring copays ranging from $0 to $480 for hospital services and $380 per stay for observation services. Ambulatory surgical center and blood services require no copay and no coinsurance, while outpatient substance abuse sessions have a $40 copay and no coinsurance.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) covers ground ambulance services with a copay of $0 to $315 and no coinsurance, while air ambulance services require a 20% coinsurance and no copay. Prior authorization is required for all ambulance services, and transportation services are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) covers emergency services with a $150 copay and no coinsurance, which is waived if 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 a $150 copay and no coinsurance for medical care, and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialist, therapy, and mental health services require a $40 to $50 copay and no coinsurance. Some chiropractic services are covered, although routine and other chiropractic services are not covered. Telehealth benefits are also available with a $0 to $45 copay and no coinsurance.
Preventive Services See details
Preventive Services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) with no copay and no coinsurance for covered benefits like annual physicals, fitness programs, and kidney disease education. Non-covered sub-services include 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, smoking cessation, enhanced disease management, telemonitoring, remote access, and counseling.
Hearing Services See details
Hearing Services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP), offering routine exams for a $40 copay and no coinsurance, and prescription hearing aids with a $399 to $699 copay and no coinsurance. OTC hearing aids and specific prescription types, including inner ear, outer ear, and over-the-ear devices, are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP), offering one annual routine eye exam with a $0 to $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $300 yearly limit with no deductible for contacts, frames, lenses, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) partially covers dental services up to a $2,000 annual maximum for both in-network and out-of-network care, offering most covered services with no copay and no coinsurance, while Medicare-covered dental services require a $40 copay and no coinsurance. 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 014 IL (PPO C-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while covered Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) covers medical equipment with no copays, featuring a 20% to 50% coinsurance for durable medical equipment and up to 20% coinsurance for prosthetics and medical supplies. Diabetic equipment is partially covered with no copay and up to 50% coinsurance for supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $95 copay for diagnostic tests. Covered radiological services require prior authorization and include outpatient X-rays with coinsurance but no copay, diagnostic radiological services starting at a $0 copay, and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by the DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered under the DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) with no coinsurance and require prior authorization, though some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is partially covered by DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) with no coinsurance, requiring prior authorization but no prior three-day 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 100-day Medicare limit are not covered.
Other Services See details
Other Services for DEVOTED C-SNP CHOICE PREMIUM 014 IL (PPO C-SNP) are partially covered, featuring Over-the-Counter (OTC) items with a $50 quarterly limit, non-Medicare diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture, meal benefits, and other unspecified services are not covered under this benefit.
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