Go Back
(4.5 / 5)Devoted Health Core Greater Houston (HMO)is a Medicare Advantage (Part C) Plan by Devoted Health.
This page features plan details for 2022 Devoted Health Core Greater Houston (HMO)H7993 – 001 – 0 available in Greater Houston.
IMPORTANT: This page features the 2022 version of this plan. See the 2024 version using the link below:
2024 Devoted CORE Greater Houston (HMO) H7993 - 001 - 0
Locations
Devoted Health Core Greater Houston (HMO)is offered in the following locations.
Brazoria County, Texas
Texas
Click to see more locations
Plan Overview
Devoted Health Core Greater Houston (HMO)offers the following coverage and cost-sharing.
| Insurer: | Devoted Health |
| Health Plan Deductible: | $0 |
| MOOP: | $3,400.00 |
| Drugs Covered: | Yes |
Ready to sign up for Devoted Health Core Greater Houston (HMO)?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
8am – 11pm EST. 7 days a week
Premium Breakdown
Devoted Health Core Greater Houston (HMO)has a monthly premium of $0. This amount includes your Part C and D premiums but does not include your Part B premium.The following is a breakdown of your monthly premium with Part B costs included.
| Part B | Part C | Part D | Part B Give Back | Total |
|---|---|---|---|---|
| $170.10 | $0.00 | $0.00 | $0.00 | $170.10 |
Please Note:
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
Devoted Health Core Greater Houston (HMO)provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $0.00 |
| Initial Coverage Limit: | $4,430.00 |
| Catastrophic Coverage Limit: | $7,050.00 |
| Drug Benefit Type: | Enhanced |
| Gap Coverage: | Yes |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.The table below shows how the LIS impacts the Part D premium of this plan.
| Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
|---|---|---|---|---|
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Initial Coverage Phase
After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00. Once you reach that amount, you will enter the next coverage phase.
30 Day
60 Day
90 Day
30 Day
60 Day
90 Day
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00, you will pay no more than the amounts below for any drug tier until you reach $7,050.00.
30 Day
90 Day
30 Day
90 Day
| Tier | Cost |
|---|---|
| All other tiers (Generic) | 25% |
| All other tiers (Brand-name) | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
| Tier | Cost |
|---|---|
| Generic | $4.15 copay or 5% (whichever costs more) |
| Brand-name | $10.35 copay or 5% (whichever costs more) |
Additional Benefits
Devoted Health Core Greater Houston (HMO)also provides the following benefits.
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
| In-Network: No |
Dental (comprehensive)
| Diagnostic services: | $0 copay (limits may apply) (authorization required) (referral required) |
| Endodontics: | $0 copay (limits may apply) (authorization required) (referral required) |
| Extractions: | $0 copay (limits may apply) (authorization required) (referral required) |
| Non-routine services: | $0 copay (limits may apply) (authorization required) (referral required) |
| Periodontics: | $0 copay (limits may apply) (authorization required) (referral required) |
| Prosthodontics, other oral/maxillofacial surgery, other services: | $0 copay (limits may apply) (authorization required) (referral required) |
| Restorative services: | $0 copay (limits may apply) (authorization required) (referral required) |
Dental (preventive)
| Cleaning: | $0 copay (limits may apply) |
| Dental x-ray(s): | $0 copay (limits may apply) |
| Fluoride treatment: | $0 copay (limits may apply) |
| Oral exam: | $0 copay (limits may apply) |
Diagnostic procedures/lab services/imaging
| Diagnostic radiology services (e.g., MRI): | $0-100 copay (authorization required) (referral required) |
| Diagnostic tests and procedures: | $0-50 copay (authorization required) |
| Lab services: | $0-25 copay (authorization required) |
| Outpatient x-rays: | $0-50 copay (authorization required) (referral required) |
Doctor visits
| Primary: | $0 copay |
| Specialist: | $15 copay per visit (referral required) |
Emergency care/Urgent care
| Emergency: | $120 copay per visit (always covered) |
| Urgent care: | $0-40 copay per visit (always covered) |
Foot care (podiatry services)
| Foot exams and treatment: | $15 copay |
| Routine foot care: | $15 copay (limits may apply) |
Ground ambulance
| $250 copay |
Health plan deductible
| $0.00 |
Health plan deductibles (other)
| In-Network: No |
Hearing
| Fitting/evaluation: | $0 copay |
| Hearing aids: | $399-699 copay (limits may apply) |
| Hearing exam: | $15 copay |
Hospital coverage (inpatient)
| $225 per stay (authorization required) |
Hospital coverage (outpatient)
| $0-150 copay per visit (authorization required) |
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
| $3,400 In-network |
Medical equipment/supplies
| Diabetes supplies: | $0 copay (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen): | 0-20% coinsurance per item (authorization required) |
| Prosthetics (e.g., braces, artificial limbs): | 0-20% coinsurance per item (authorization required) |
Medicare Part B drugs
| Chemotherapy: | 20% coinsurance (authorization required) |
| Other Part B drugs: | 0-20% coinsurance (authorization required) |
Mental health services
| Inpatient hospital – psychiatric: | $350 per stay (authorization required) |
| Outpatient group therapy visit with a psychiatrist: | $15 copay (authorization required) |
| Outpatient group therapy visit: | $15 copay (authorization required) |
| Outpatient individual therapy visit with a psychiatrist: | $15 copay (authorization required) |
| Outpatient individual therapy visit: | $15 copay (authorization required) |
Optional supplemental benefits
| No |
Preventive care
| $0 copay |
Rehabilitation services
| Occupational therapy visit: | $0-40 copay (referral required) |
| Physical therapy and speech and language therapy visit: | $0-40 copay (authorization required) (referral required) |
Skilled Nursing Facility
| $0 per day for days 1 through 20 $178 per day for days 21 through 40 $0 per day for days 41 through 100 (authorization required) |
Transportation
| $0 copay (limits may apply) |
Vision
| Contact lenses: | $0 copay (limits may apply) |
| Eyeglass frames: | $0 copay (limits may apply) |
| Eyeglass lenses: | $0 copay (limits may apply) |
| Eyeglasses (frames and lenses): | $0 copay (limits may apply) |
| Other: | Not covered |
| Routine eye exam: | $0 copay (limits may apply) |
| Upgrades: | $0 copay (limits may apply) |
Wellness programs (e.g., fitness, nursing hotline)
| Covered |
Ready to sign up for Devoted Health Core Greater Houston (HMO)?
Get help from a licensed insurance agent.
Call 1-877-354-4611 / TTY 711.
8am – 11pm EST. 7 days a week
Table of Contents
Get Help Enrolling
Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint
SMID: MULTIPLAN_HCIHNDOGMED01_M
Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.
Medicare has neither approved nor endorsed any information on this site.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
All plan-related information on this site is from CMS.gov and Medicare.gov.We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period.
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contactMedicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
© All rights reserved | About | Contact | Legal and Privacy
