A non-government entity
DEVOTED C-SNP CHOICE PREMIUM 005 WA (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 005 WA (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 005 WA (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Washington. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 005 WA (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 005 WA (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 005 WA (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 005 WA (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $10.50. 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 $11100.00 (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 $11100.00 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 005 WA (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 005 WA (PPO C-SNP) plan features an annual prescription drug deductible of $615. Under this plan, Tier 6 select care drugs are highly affordable with no copay for one, two, or three-month supplies at standard pharmacies and through standard mail order. For other generic medications, you will pay an $18 copay for a one-month supply of Tier 1 preferred generics and a $19 copay for a one-month supply of Tier 2 generics. Higher-tier medications are covered through coinsurance at standard pharmacies and standard mail order during the initial coverage phase. Tier 3 preferred brand drugs require a 21% coinsurance, while Tier 4 non-preferred drugs carry a 33% coinsurance. Tier 5 specialty drugs require a 25% coinsurance for a one-month supply, with multi-month supplies unavailable for this tier.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and preventive care. For inpatient hospital stays, members pay a daily copay of $505 for days 1 through 4, followed by no copay for days 5 through 90. Specialist visits, physical therapy, and outpatient mental health services are also accessible with a $50 copay and no coinsurance. This plan features robust ancillary benefits, including up to a $2,000 annual maximum for preventive and comprehensive dental care with no copay. Additionally, members receive a $300 yearly allowance for eyewear with no copay, a $50 quarterly over-the-counter allowance, and routine hearing exams for a $50 copay. Emergency services are covered with a $115 copay, which is waived if you are admitted to the hospital within 24 hours.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) partially covers inpatient hospital services with no coinsurance, requiring a $505 daily copay for days 1 through 4 and no copay for days 5 through 90 for both acute and psychiatric stays. Non-Medicare-covered stays, acute upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) covers outpatient services with no coinsurance, offering ambulatory surgical and blood services with no copay. Outpatient hospital services require a $0 to $605 copay, observation services have a $505 copay per stay, and outpatient substance abuse sessions require a $50 copay.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) covers partial hospitalization services with a $60.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) covers ambulance services with prior authorization, requiring a copay ranging from no copay to $315 and coinsurance for ground transport, and a 20% coinsurance and copay for air transport. Some transportation services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (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 range from no copay to a $40 copay with no coinsurance, and worldwide emergency services are covered up to a $25,000 limit with a $115 copay for emergency or urgent care and a $315 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require a $50 copay and no coinsurance. Occupational therapy is available with a $35 copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) with no copay and no coinsurance for services like annual physicals, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding in-home safety assessments, personal emergency response systems (PERS), post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, 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
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) covers routine hearing exams with a $50 copay and no coinsurance, while prescription hearing aids are partially covered with copays ranging from $399 to $699 and no coinsurance. Over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) offers partially covered vision services, including one annual routine eye exam with a $0 to $50 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, providing up to a $300 yearly maximum benefit for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by the DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) plan up to a $2,000 annual maximum, with covered preventive and comprehensive benefits requiring no copay and no coinsurance, and Medicare-covered services requiring a $50 copay and no coinsurance. Other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) covers home infusion bundled services with no copay, though prior authorization and step therapy are required. Under this plan, Medicare Part B chemotherapy and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%. Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) covers medical equipment with no copay and prior authorization required, featuring a 20% coinsurance for durable medical equipment and coinsurance ranging from no coinsurance to 20% for prosthetics and medical supplies. Diabetic equipment is partially covered with coinsurance ranging from no coinsurance to 20% for diabetic supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) covers diagnostic and radiological services with prior authorization required. Lab services and outpatient X-rays have no copay and no coinsurance, diagnostic procedures and tests range from a $0 to $95 copay with no coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) with no coinsurance and prior authorization required, though only some services are covered. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($30 copay), pulmonary rehabilitation ($25 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) covers skilled nursing facility (SNF) services with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20, followed by a daily copay of $218 for days 21 through 100, though prior authorization is required and additional days beyond the standard Medicare limit are not covered.
Other Services See details
DEVOTED C-SNP CHOICE PREMIUM 005 WA (PPO C-SNP) partially covers other services, offering acupuncture, non-Medicare diabetic shoes, and additional preventive services with no copay and no coinsurance. This benefit also includes a $50 quarterly over-the-counter item allowance with no copay and no coinsurance, while meal benefits are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved