Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP CHOICE PREMIUM 011 AL (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 011 AL (PPO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) is a PPO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in North Alabama. 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 011 AL (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 011 AL (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.
Below are a few key facts and commonly-asked questions about DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP).
The cost of a Medicare Advantage Plan is made up of four main parts.
For DEVOTED C-SNP CHOICE PREMIUM 011 AL (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.
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The DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) plan features a basic alternative drug benefit with an annual prescription drug deductible of $615. During the initial coverage phase, you will pay a $19 copay for Tier 1 preferred generics, a 21% coinsurance for Tier 2 standard generics, and a 33% coinsurance for Tier 3 preferred brands. Tier 4 non-preferred drugs require a 25% coinsurance, while Tier 5 specialty drugs have no copay at standard pharmacies and through standard mail. These cost-sharing rates apply to a 30-day supply until your total drug costs reach $2,100. Once your yearly out-of-pocket drug costs reach $2,100, you enter the catastrophic coverage phase where you pay nothing for covered Medicare Part D drugs. Additionally, individuals who qualify for the low-income subsidy will see their Part D premium reduced to $27.70.
The DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) plan offers comprehensive medical coverage with predictable out-of-pocket costs, including no copay for Medicare-covered preventive services, annual physicals, and fitness benefits. Inpatient hospital stays require a $370 daily copay for days one through seven and no copay for days eight through 90, while primary and specialist visits range from no copay up to $50 with no coinsurance. Outpatient hospital services also feature no coinsurance, with copays ranging from no copay up to $470. Additional benefits include a dental allowance of up to $2,000 with no copay for most covered services, a $300 annual eyewear allowance, and routine hearing exams for a $35 copay. Members also receive a $50 quarterly allowance for over-the-counter items, as well as diagnostic lab and outpatient X-ray services with no copay. Skilled nursing facility stays are also covered with no copay for the first 20 days.
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) covers inpatient acute hospital stays with a $370 daily copay for days 1 to 7 and no copay for days 8 to 90, as well as psychiatric stays with a $370 daily copay for days 1 to 6 and no copay for days 7 to 90. Both benefits require no coinsurance, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient services are covered by DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) with no coinsurance for all benefits. Copayments range from $0 to $470 for outpatient hospital services, $370 per stay for observation services, $35 for outpatient substance abuse sessions, and no copay for ambulatory surgical center services.
Partial hospitalization benefits are covered by DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) with a $70 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP), as transportation services to plan-approved or any other health-related locations are not covered. Covered ground ambulance services require a copay between $0 (no copay) and $405 in addition to a coinsurance, while air ambulance services require a 20% coinsurance and a copay.
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services are covered with no coinsurance and a copay ranging from no copay to $45. Worldwide emergency services have a $25,000 maximum benefit, with a $130 copay for emergency and urgent care, and a $405 copay plus 20% coinsurance for emergency transportation.
Primary care benefits are covered by DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) with copays ranging from no copay up to $50 and no coinsurance for services including specialist visits, therapy, and telehealth. Chiropractic services are partially covered under this plan, as routine chiropractic care is not covered.
Preventive services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP), featuring no copay for Medicare-covered zero-dollar preventive services, annual physicals, and fitness benefits. Some sub-services are not covered under this plan, including in-home safety assessments, personal emergency response systems, therapeutic massages, and caregiver support.
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) partially covers hearing services, offering routine exams for a $35 copay and up to two prescription hearing aids per year with a $399 to $699 copay, both with 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 are covered by DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP), featuring eye exams with a copay of up to $35 (or no copay for routine exams) and no coinsurance. The plan also provides up to a $300 annual allowance for eyewear, including contacts and glasses, with no copay, coinsurance, or deductible.
Dental services are partially covered by DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP), offering up to a $2,000 annual maximum for both in- and out-of-network care with no copay and no coinsurance for most covered services. Medicare-covered dental services require a $35 copay and no coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) covers Home Infusion bundled services, including Part B drugs, with prior authorization required. Covered Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance up to 20%, while chemotherapy, radiation, and other Part B drugs have no copay and coinsurance ranging from no coinsurance up to 20%.
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) covers Dialysis Services with 20% coinsurance and no copay. Prior authorization is required to access these covered services.
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) partially covers medical equipment, though diabetic therapeutic shoes and inserts are not covered. Covered benefits require no copay, with coinsurance ranging from 20% to 50% for durable medical equipment, no coinsurance to 20% for prosthetics and medical supplies, and no coinsurance to 50% for diabetic supplies.
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) covers diagnostic and radiological services with prior authorization, offering lab services and outpatient X-rays with no copay and no coinsurance. Diagnostic procedures and tests require a copay of $0 to $95 with no coinsurance, and diagnostic radiological services carry a copay of up to $300 with no coinsurance. Therapeutic radiological services require a 20% coinsurance and no copay.
Home health services are covered by the DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) plan, though prior authorization is required. Please refer to the plan details for specific copay and coinsurance costs associated with these services.
DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) covers Cardiac Rehabilitation Services with prior authorization, though some services are covered while Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. Specific copay and coinsurance details are not provided for this benefit.
Skilled Nursing Facility (SNF) services are partially covered under DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP), as additional days beyond the Medicare-covered limit are not covered. Covered stays require prior authorization and feature no copay and no coinsurance for days 1 through 20, and a $218 daily copay with no coinsurance for days 21 through 100.
Other services are partially covered by the DEVOTED C-SNP CHOICE PREMIUM 011 AL (PPO C-SNP) plan, which features a $50 quarterly allowance with no carryover for over-the-counter items, as well as coverage for non-Medicare covered diabetic shoes and additional preventive services. Acupuncture, meal benefits, and highly integrated dual-eligible SNP services are not covered under this plan.
SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
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* 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.
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