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DEVOTED C-SNP CHOICE PREMIUM 017 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 017 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 017 TN (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Knoxville. 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 017 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 017 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 017 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 017 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 017 TN (PPO C-SNP) Medicare plan features an annual drug deductible of $615. Under this plan, Select Care Drugs (Tier 6) are available with no copay for one-month, two-month, or three-month supplies through standard pharmacies and standard mail order. For other generic medications, standard pharmacy and mail-order copays range from $18 to $54 for Tier 1 Preferred Generics, and $19 to $57 for Tier 2 Generics, depending on the supply length. Higher-tier medications under this plan are subject to coinsurance rather than set copayments. Standard pharmacy and mail-order fills require a 21% coinsurance for Tier 3 Preferred Brand drugs and a 33% coinsurance for Tier 4 Non-Preferred Drugs. Tier 5 Specialty medications are covered with a 25% coinsurance for a one-month supply.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) plan offers comprehensive medical coverage with affordable, predictable out-of-pocket costs. Members benefit from no copay for primary care doctor visits, preventive services, and home health care, while specialist visits require a $35 copay. Inpatient hospital stays require a daily copay of $375 for the first five days, followed by no copay for days six through ninety, with no coinsurance. This plan also features robust dental, vision, and hearing benefits to help manage your overall wellness. Dental services are covered with no copay up to a $2,000 annual limit, and vision eyewear is covered with no copay up to a $300 yearly maximum. Additionally, prescription hearing aids are available with copays ranging from $399 to $699, and members receive a $50 over-the-counter item allowance every three months.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) with no coinsurance, requiring a daily copay of $375 for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require a copay ranging from $0 to $475, observation services carry a $375 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) covers partial hospitalization services with a $60 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP), featuring a copay of $0 to $315 for ground ambulance and 20% coinsurance for air ambulance services. For transportation, 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 017 TN (PPO C-SNP) covers emergency services with a $130 copay (waived if admitted within 24 hours) and no coinsurance, while urgently needed services range from no copay to a $45 copay with no coinsurance. Worldwide emergency and urgent care are covered up to a $25,000 limit with a $130 copay and no coinsurance, while worldwide emergency transportation costs a $315 copay and 20% coinsurance.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) offers primary care physician services with no copay and no coinsurance, while specialist, mental health, psychiatric, and podiatry visits require a $35 copay and no coinsurance. Physical and occupational therapy services have a $35 to $50 copay and no coinsurance, and telehealth benefits range from no copay to a $45 copay with no coinsurance. Some chiropractic services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) with no copay and no coinsurance for annual physical exams, fitness benefits, and nutritional training. This benefit is partially covered, as specific sub-services like in-home safety assessments, personal emergency response systems (PERS), therapeutic massage, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP), featuring routine exams for a $35 copay and no coinsurance, and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $399 and $699, though OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP), offering one routine eye exam per year with a $0 to $35 copay, no coinsurance, and no deductible, while other eye exam services are not covered. Eyewear is fully covered with no copay, no coinsurance, and a $300 combined annual maximum benefit for contacts, eyeglasses, frames, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) offers partially covered dental services with a $2,000 annual maximum benefit for both in-network and out-of-network care. Covered preventive and comprehensive dental services require no copay and no coinsurance, while Medicare-covered dental services have a $35 copay and no coinsurance; however, implant services, orthodontics, maxillofacial prosthetics, other diagnostic services, and other preventive services are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, insulin, and other infusion drugs are covered with no coinsurance to 20% coinsurance, with insulin specifically requiring a $35 copay and no deductible.
Dialysis Services See details
Dialysis Services are covered under the DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) plan 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 017 TN (PPO C-SNP) covers medical equipment with no copays, subject to prior authorization. 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 supplies, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) with prior authorization required. Diagnostic services feature no coinsurance, offering lab services with no copay and diagnostic procedures with copays ranging from no copay up to $95. Outpatient X-rays require no copay, diagnostic radiological services start with no copay, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Home Health Services are covered by DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) 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 017 TN (PPO C-SNP) with no coinsurance, though prior authorization is required. Some services are covered, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require copayments of $25 to $35.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior 3-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the standard Medicare-covered limit.
Other Services See details
Other services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 017 TN (PPO C-SNP), offering over-the-counter items with a fifty-dollar limit every three months, non-Medicare diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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