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DEVOTED C-SNP CHOICE PREMIUM 009 NE (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 009 NE (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 009 NE (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in Nebraska. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP CHOICE PREMIUM 009 NE (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 009 NE (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 009 NE (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 009 NE (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.40. 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 $6700.00 (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 $6700.00 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 009 NE (PPO C-SNP) Medicare plan features an annual drug deductible of $615. For Tier 6 Select Care drugs, members enjoy no copay for 1-month, 2-month, and 3-month supplies filled at standard pharmacies or through standard mail order. Tier 1 Preferred Generic drugs carry an $18 copay for a 1-month supply, while Tier 2 Generic drugs cost $19 per month. Brand-name and specialty medications require coinsurance payments at standard pharmacies and mail-order services. Tier 3 Preferred Brand drugs have a 21% coinsurance, Tier 4 Non-Preferred drugs require a 33% coinsurance, and Tier 5 Specialty Tier drugs require a 25% coinsurance for a 1-month supply. Standard mail order and standard retail pharmacy options share identical pricing across all coverage tiers.
Additional Benefits
The DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) plan offers comprehensive medical coverage featuring no copay for primary care physician visits, home health services, and cardiac rehabilitation. For inpatient hospital stays, members pay a daily copay of $475 for days one through five, with no copay required for any additional days. Emergency services carry a $130 copay that is waived upon admission, while urgently needed care ranges from no copay to a $45 copay. This plan also provides valuable specialty benefits, including up to $2,000 in covered dental services and a $400 annual allowance for eyewear with no copay. Routine hearing exams require a $45 copay, while covered prescription hearing aids carry a copay between $399 and $699. Finally, members benefit from no copay on diagnostic lab services, outpatient X-rays, and ambulatory surgical center visits.
Inpatient Hospital See details
Inpatient Hospital coverage under DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) requires prior authorization and features no coinsurance, with acute stays requiring a $475 copay for days 1 to 5 (no copay thereafter) and psychiatric stays requiring a $465 copay for days 1 to 5 (no copay for days 6 to 90). Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) with no coinsurance, featuring copays of $0 to $575 for hospital outpatient services and $475 per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) plan with a $130.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) covers ambulance services with prior authorization, featuring a copay ranging from no copay to $340 for ground transport and a 20% coinsurance for air transport. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 NE (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 services are covered up to a $25,000 limit with a $130 copay for emergency or urgent care, and a $340 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) covers primary care physician services with no copay and no coinsurance. Specialist visits, mental health sessions, and therapy services are covered with copays ranging from $0 to $50 and no coinsurance, while chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under the DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) plan with no copay and no coinsurance for covered care, including annual physicals, fitness benefits, and glaucoma screenings. While many benefits are included, several sub-services are not covered, such as in-home safety assessments, personal emergency response systems, therapeutic massage, and counseling services.
Hearing Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) partially covers hearing services, including one annual routine exam for a $45 copay and no coinsurance, and unlimited fitting evaluations with no copay and no coinsurance. Covered prescription hearing aids require a $399 to $699 copay and no coinsurance, while over-the-counter (OTC) hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP), offering one annual routine eye exam with a $0 to $45 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $400 yearly maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) partially covers dental services, offering Medicare-covered dental with a $45 copay and no coinsurance, and other covered dental services with no copay and no coinsurance up to a $2,000 annual maximum. However, other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) with no copay, requiring prior authorization. Covered Medicare Part B chemotherapy and other drugs carry no copay and no coinsurance to 20% coinsurance, while Medicare Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) plan with no copay and 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) covers medical equipment with no copays, though prior authorization is required. Durable medical equipment requires a 20% to 50% coinsurance, and prosthetics and medical supplies range from no coinsurance to 20% coinsurance. Diabetic equipment is partially covered, offering diabetic supplies with no coinsurance to 50% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) covers diagnostic and radiological services with prior authorization, featuring no copay for lab services and outpatient X-rays, and no coinsurance for diagnostic tests. Diagnostic procedures and tests require a copay between $0 and $95, while therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home health services are covered by DEVOTED C-SNP CHOICE PREMIUM 009 NE (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 009 NE (PPO C-SNP) with no copay and no coinsurance, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered. Prior authorization is required for these rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) with no coinsurance and no prior three-day hospital stay required. There is no copay for days 1 through 20 and a $218 copay per day for days 21 through 100, though prior authorization is required and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 009 NE (PPO C-SNP) with no copay and no coinsurance, which includes a $50 quarterly over-the-counter benefit, non-Medicare covered diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and highly integrated services for dual-eligible SNPs are not covered.
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