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DEVOTED C-SNP CHOICE PREMIUM 016 TN (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 016 TN (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 016 TN (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Chattanooga. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 016 TN (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 016 TN (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 016 TN (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 016 TN (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.70. 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 $9850.00 (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 $9850.00 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:
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Drug Coverage
The DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, you will pay an $18 copay for a 1-month supply at standard pharmacies and standard mail order. Tier 2 generic drugs carry a $19 copay for a 1-month supply, while Tier 6 select care drugs are available with no copay. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. You will pay 21% coinsurance for Tier 3 preferred brand drugs and 33% coinsurance for Tier 4 non-preferred drugs through standard pharmacies and mail order. Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) plan offers robust medical coverage with no copay for primary care visits, telehealth, and preventive services. For more intensive care, inpatient hospital stays require a $375 daily copay for days one through five and no copay for days six through 90, with no coinsurance. Outpatient hospital services carry copays up to $475, while emergency room visits carry a $130 copay that is waived upon admission. This plan also includes valuable supplemental benefits, providing covered dental services with no copay up to a $2,000 annual limit and a $300 yearly allowance for eyewear with no copay. Routine hearing and eye exams feature copays up to $35, while prescription hearing aids require copays between $399 and $699. For specialized needs, skilled nursing facility stays require no copay for the first 20 days, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) with no coinsurance, requiring a $375 daily copay for days 1 through 5 and no copay for days 6 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional inpatient psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) covers outpatient services with no coinsurance across all categories. Ambulatory surgical center and blood services feature no copay, while outpatient hospital services require a $0 to $475 copay, observation services have a $375 copay per stay, and outpatient substance abuse sessions carry a $35 copay.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) covers partial hospitalization benefits with an $85.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP), as transportation services to plan-approved or any health-related locations are not covered. Covered ground ambulance services require coinsurance and a copay ranging from no copay to $315, while air ambulance services require a 20% coinsurance and a copay, with prior authorization required for both.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (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 require no copay to a $45 copay with no coinsurance, while worldwide emergency and urgent care are covered up to $25,000 with a $130 copay, and worldwide emergency transportation requires a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) covers primary care physician services and telehealth benefits with no copay and no coinsurance. Specialist visits, mental health, podiatry, and therapy services are covered with copays ranging from $0 to $50 and no coinsurance, while for chiropractic services, some services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) offers partially covered preventive services with no copay and no coinsurance for covered services like annual physical exams, kidney disease education, and fitness benefits. However, several supplemental services are not covered, including in-home safety assessments, personal emergency response systems (PERS), 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, enhanced disease management, telemonitoring, remote access technologies, and counseling.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) hearing services are partially covered, featuring routine exams for a $35 copay and no coinsurance, and prescription hearing aids with a $399 to $699 copay and no coinsurance. OTC hearing aids, along with inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) offers partially covered vision services, featuring one routine eye exam per year with a $0 to $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance, providing a combined maximum benefit of $300 per year for contacts, eyeglasses, and upgrades.
Dental Services See details
Dental services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP), featuring a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered dental services up to a $2,000 annual limit. While routine cleanings, exams, and fillings are covered, this plan does not cover other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, or orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) with no copay, though prior authorization and step therapy may be required. Associated Medicare Part B drugs, including chemotherapy, radiation, and other covered medications, carry a coinsurance ranging from 0% (no coinsurance) to 20%, while Part B insulin has a $35 copay and a coinsurance of 0% (no coinsurance) to 20%.
Dialysis Services See details
Dialysis services are covered by the DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for this benefit.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment has a 20% coinsurance, while prosthetics, medical supplies, and diabetic supplies range from no coinsurance to 20% coinsurance, with diabetic therapeutic shoes and inserts being not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by the DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) plan, with prior authorization required for both. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic tests with a $0 to $95 copay, while radiological services require no copay for diagnostic and X-ray services and a minimum 20% coinsurance for therapeutic services.
Home Health Services See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) with no coinsurance, though prior authorization is required and only some services are covered. Specific services such as cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require copays ranging from $25 to $35.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond Medicare-covered days are not covered.
Other Services See details
DEVOTED C-SNP CHOICE PREMIUM 016 TN (PPO C-SNP) provides partially covered other services, including over-the-counter items, diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan, and the over-the-counter benefit features a fifty dollar maximum coverage limit every three months.
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