Devoted PREMIUM Tennessee (HMO)
Tennessee Medicare Advantage Plan (2024 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating (new plan)
Plan Name
Devoted PREMIUM Tennessee (HMO)
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Devoted PREMIUM Tennessee (HMO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Tennessee and offered by the health insurance company Devoted Health. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$15 copay per visit
ER visit
$120 copay per visit (always covered)
Devoted PREMIUM Tennessee (HMO) has a monthly premium cost of $22 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $3,900 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Devoted PREMIUM Tennessee (HMO) are defined below.
Yes
Part D Prescription Drug Coverage
Devoted PREMIUM Tennessee (HMO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Devoted PREMIUM Tennessee (HMO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Devoted PREMIUM Tennessee (HMO) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Tests, labs, & imaging
Diagnostic tests & procedures
Diagnostic radiology services (like MRI)
Emergency care
$120 copay per visit (always covered)
Urgent care
$0-40 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
$175 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage
Skilled nursing facility
Skilled nursing facility
$0 per day for days 1 through 20
$203 per day for days 21 through 100
Preventive services
Ambulance
Therapy services
Occupational therapy visit
Physical therapy & speech & language therapy visit
Mental health services
Outpatient group therapy with a psychiatrist
Outpatient individual therapy with a psychiatrist
Outpatient group therapy visit
Outpatient individual therapy visit
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
0-20% coinsurance per item
Prosthetics (like braces, artificial limbs)
0-20% coinsurance per item
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
---|
Preferred Generic | $0.00 copay | $0.00 copay | $0 copay |
Generic | $0.00 copay | $0.00 copay | $0 copay |
Preferred Brand | $45.00 copay | | $0 copay |
Non-Preferred Drug | $95.00 copay | | $0 copay |
Specialty Tier | 33% | | $0 copay |
1 * The above cost-sharing only applies to some drugs on this tier. For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. |
Part B Drugs
Hearing
Preventive Dental
Comprehensive dental
Prosthodontics, other oral/maxillofacial surgery, other services
Vision
Eyeglasses (frames & lenses)
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