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DEVOTED C-SNP PLUS 004 NM (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for DEVOTED C-SNP PLUS 004 NM (HMO 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 PLUS 004 NM (HMO C-SNP) in 2026, please refer to our full plan details page.
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) is a HMO C-SNP plan offered by Devoted Health, Inc. available for enrollment in 2026 to people living in New Mexico. The overall rating for this plan is not yet available for 2026.
It's important to know that DEVOTED C-SNP PLUS 004 NM (HMO 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 PLUS 004 NM (HMO 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 PLUS 004 NM (HMO 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 PLUS 004 NM (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 Maximum Out-Of-Pocket cost of $9250.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 PLUS 004 NM (HMO C-SNP) plan features an annual drug deductible of $615 before coverage begins. Under this plan, you will enjoy no copay for Tier 6 Select Care Drugs filled through standard pharmacies or standard mail order. For other low-tier medications, Tier 1 Preferred Generic drugs have an $18 copay and Tier 2 Generic drugs have a $19 copay for a one-month supply at standard pharmacies or mail-order services. For higher-tier medications, costs transition to a percentage of the drug cost. Tier 3 Preferred Brand drugs and Tier 5 Specialty Tier drugs require a 25% coinsurance, while Tier 4 Non-Preferred drugs require a 31% coinsurance at standard pharmacies and mail-order services. Understanding these copay, coinsurance, and deductible structures is essential to determining your total out-of-pocket prescription costs under this Medicare plan.
Additional Benefits
The DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) plan offers robust coverage with no copays or coinsurance for primary care visits, preventive services, and home health care. Dental benefits feature no copays or coinsurance for most services up to a $3,000 annual limit, while vision care includes a $400 yearly allowance for eyewear. Routine hearing exams and prescription hearing aids are also covered, featuring no deductibles and affordable copayments. For hospital stays, there is no coinsurance, though inpatient acute care requires a $2,230 copay per stay and skilled nursing facilities require a daily copay after twenty days. Outpatient services and diagnostic tests feature no copays, but are subject to varying coinsurance rates. Emergency room visits carry a $115 copay, which is waived if you are admitted to the hospital within twenty-four hours.
Inpatient Hospital See details
Inpatient hospital services are partially covered by DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) 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 for these services, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) covers outpatient services with no copays, though prior authorization is required and coinsurance charges apply. Coinsurance ranges from 0% to 50% for outpatient hospital and ambulatory surgical center services, and is 30% for outpatient substance abuse and blood services.
Partial Hospitalization See details
Partial hospitalization is covered by DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) with no copay and a 20% coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) covers ambulance services with no copay, requiring a 50% coinsurance for air ambulance and between no coinsurance and 50% coinsurance for ground ambulance. For transportation services, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Emergency services are covered by DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) with a $115 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require no copay and a 0% to 20% coinsurance (up to $40), while worldwide emergency, urgent, and transportation services are covered up to $25,000 with no copay and no coinsurance.
Primary Care See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) offers primary care physician services with no copay and no coinsurance, while chiropractic services are not covered. Other covered services, such as specialist visits, mental health care, and physical therapy, require prior authorization and have no copay and 30% coinsurance.
Preventive Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) offers partially covered preventive services with no copay and no coinsurance for covered care, including annual physicals, fitness benefits, and kidney disease education. However, certain sub-services are not covered under this plan, such as in-home safety assessments, personal emergency response systems, therapeutic massage, adult day health, and in-home support services.
Hearing Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) provides hearing services with no deductible, no copay for exams (though routine exams require 50% coinsurance), and prescription hearing aids with no coinsurance and a $399 to $699 copay. This benefit is partially covered because over-the-counter hearing aids, as well as inner ear, outer ear, and over-the-ear prescription aids, are not covered.
Vision Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) covers vision services with no deductibles, offering one annual routine eye exam with no copay and 0% to 50% coinsurance, although other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance up to a $400 yearly limit for contacts, eyeglasses, and upgrades.
Dental Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) offers partially covered dental services up to a $3,000 annual maximum with no copay and no coinsurance for most preventive and comprehensive care, though Medicare-covered dental has no copay and a 30% coinsurance. Specific services such as other diagnostic, other preventive, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other Part B drugs have no coinsurance to 20% coinsurance, while Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) partially covers medical equipment with no copays, though prior authorization is required for these benefits. Durable medical equipment and diabetic supplies are subject to a 20% coinsurance, while prosthetic devices and medical supplies range from no coinsurance to 20% coinsurance; diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) covers diagnostic and radiological services with prior authorization required and no copays. You will pay no coinsurance for diagnostic procedures and tests, 50% coinsurance for lab services, 20% coinsurance for therapeutic radiological services, and 45% coinsurance for diagnostic radiological and outpatient X-ray services.
Home Health Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) covers cardiac rehabilitation services with no copay, subject to prior authorization. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require a 30% coinsurance.
Skilled Nursing Facility (SNF) See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the standard Medicare limit.
Other Services See details
DEVOTED C-SNP PLUS 004 NM (HMO C-SNP) offers partial coverage for other services with no copay and no coinsurance, which includes over-the-counter (OTC) items up to $50 every three months, non-Medicare diabetic shoes, and additional preventive services. Acupuncture, meal benefits, and dual-eligible SNP services are not covered under this plan.
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