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DEVOTED C-SNP CHOICE PLUS 020 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 PLUS 020 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 PLUS 020 TN (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Tennessee. 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 PLUS 020 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 PLUS 020 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 PLUS 020 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 PLUS 020 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 has a $850.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $13900.00 (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 $13900.00 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 PLUS 020 TN (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 PLUS 020 TN (PPO C-SNP) Medicare plan has an annual drug deductible of $615. Under this plan, standard pharmacies and standard mail-order services offer Tier 1 preferred generic drugs for an $18 copay and Tier 2 generic drugs for a $19 copay for a 1-month supply. Additionally, there is no copay for Tier 6 select care drugs for 1-month, 2-month, or 3-month supplies. For brand-name and specialty medications, costs are calculated using coinsurance. Standard pharmacy and mail-order fills for Tier 3 preferred brand drugs and Tier 5 specialty drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 31% coinsurance. Coinsurance rates apply to all supply lengths, though Tier 5 specialty drugs are restricted to 1-month supplies.
Additional Benefits
The DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, preventive services, and home health care. For hospital stays, members pay a flat copay of $2,230 per acute care stay and $2,080 per psychiatric stay with no coinsurance, while emergency room visits carry a $115 copay. Outpatient services, diagnostic testing, and skilled nursing care are also covered, though coinsurance and daily copays may apply depending on the service. Supplemental benefits include dental services up to a $2,000 annual maximum and eyewear up to a $300 yearly limit, both featuring no copay. Prescription hearing aids are covered with a copay between $399 and $699, and members receive a $50 allowance every three months for over-the-counter health items with no copay. Essential needs like durable medical equipment and dialysis are also accessible with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) covers inpatient hospital services with no coinsurance, requiring a $2,230 copay per stay for acute care and a $2,080 copay per stay for psychiatric care. Prior authorization is required, and while acute care includes unlimited additional days, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under the DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) plan are covered with no copayments, though coinsurance and prior authorization requirements apply to most care. Specifically, outpatient hospital and ambulatory surgical center services require no copay and 0% to 50% coinsurance, while outpatient substance abuse and blood services feature no copay and 30% coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
Ambulance services are covered by DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) with no copay, requiring prior authorization, a 50% coinsurance for air transport, and a coinsurance ranging from no coinsurance to 50% for ground transport. For transportation, some services are covered, but transportation to plan-approved and any health-related locations is not covered.
Emergency Services See details
DEVOTED C-SNP CHOICE PLUS 020 TN (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 feature no copay and 0% to 20% coinsurance (up to $40 per visit), while worldwide emergency, urgent, and transportation services are covered up to a $25,000 limit with no copay and no coinsurance.
Primary Care See details
DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) offers primary care physician services with no copay and no coinsurance, while routine and other chiropractic services are not covered. Other covered services—including specialists, physical and occupational therapy, mental health, and routine podiatry—require no copay and 30% coinsurance, with telehealth options available at no copay and 0% to 30% coinsurance.
Preventive Services See details
Preventive Services are partially covered by DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) with no copay and no coinsurance for covered options like annual physicals, fitness programs, and nutritional training. While many health and wellness benefits are included, some sub-services are not covered, such as in-home safety assessments, personal emergency response systems, therapeutic massage, and in-home support services.
Hearing Services See details
Hearing services are partially covered by DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP), featuring routine hearing exams with no copay and a 50% coinsurance, alongside fitting evaluations with no copay or coinsurance. Prescription hearing aids are also partially covered with no coinsurance and a copay of $399 to $699, though OTC devices and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are covered under the DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) plan, offering one routine eye exam per year with no copay and 0% to 50% coinsurance, though other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to a $300 combined annual maximum.
Dental Services See details
Dental services are partially covered under the DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) plan, featuring Medicare-covered dental services with no copay and 30% coinsurance, and other dental services with no copay and no coinsurance up to a $2,000 annual maximum. While many preventive and comprehensive services are covered, other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) covers Home Infusion bundled services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs require no copay and a coinsurance of no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) partially covers medical equipment with no copays, though prior authorization is required for these services. Durable medical equipment and diabetic supplies require a 20% coinsurance, while covered prosthetics and medical supplies range from no coinsurance to 20% coinsurance. Diabetic therapeutic shoes and inserts are not covered under this benefit.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) covers diagnostic and radiological services with no copays, though prior authorization is required for all services. Diagnostic procedures and tests carry no coinsurance, while therapeutic radiology requires 20% coinsurance, and lab services, diagnostic radiology, and outpatient X-rays require 50% coinsurance.
Home Health Services See details
Home Health Services are covered under the DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) covers some Cardiac Rehabilitation Services with no copay, though prior authorization is required. However, several sub-services are not covered in practice, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services, which carry a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) covers Skilled Nursing Facility (SNF) services 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 limit are not covered.
Other Services See details
Other services under the DEVOTED C-SNP CHOICE PLUS 020 TN (PPO C-SNP) are partially covered, offering over-the-counter (OTC) items, diabetic shoes, and additional preventive services with no copay and no coinsurance. Acupuncture and meal benefits are not covered, and the covered OTC items are limited to a maximum benefit of $50 every three months.
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