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Medicare Advantage · Local PPO
Devoted Health
Plan year 2026

DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP) H0413-003

Monthly premium
$31.20
+ your Part B premium
Max out-of-pocket
$9,250
in-network annual cap
Primary care
$0
per visit copay
Specialist
30%
per visit
Eligibility required for this C-SNP
The plan must verify that you have one of its qualifying chronic or disabling conditions, such as Cardio DIS CHF and Diabetes. If the plan uses a pre-enrollment assessment, provider verification is due by the end of your first month of enrollment. If verification is still missing, the plan must notify you and may disenroll you at the end of your second month. Your coverage continues if verification arrives before then. Review the official plan documents for the exact criteria.

Your costs at a glanceIn-network, for the 2026 plan year

Rx deductible
$615
Inpatient hospital
$2,230
per stay
no limit on covered hospital days
Inpatient mental health
$2,080
per stay
Emergency room
$115

What's included, and what it's actually worth5 benefits included. Tap any card for the detail

Dental

$3,000/yr allowance
Annual max$3,000/yr allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.

OTC allowance

$50/quarter OTC allowance
Prepaid card$50/quarter OTC allowance

Hearing

$399–$699copay per hearing aid
Details$399–$699 copay per hearing aid
This is a supplemental benefit with plan-specific limits. See plan documents for details.

Vision

$300/yr eyewear allowance
Eyewear allowance$300/yr eyewear allowance
This is a supplemental benefit with plan-specific limits. See plan documents for details.
See more details about this plan
Doctor Visits: PCP$0 copay
In-network$0 copay per visit
Doctor Visits: Specialist30%
In-network30% per visit
Inpatient Hospital$2,230 per stay
In-network$2,230 per stay
Benefit limitNone — additional covered days are unlimited
Mental Health$2,080 per stay
Inpatient psychiatric$2,080 per stay
MealsMeal benefit

Your coverageCheck your coverageFrom the doctors and prescriptions you added

Your plan's drug tiers30-day retail · after any applicable deductible

Tier 1
$18
Preferred Generic
Tier 2
$19
Generic
Tier 3
25%
Preferred Brand· after deductible
Tier 4
31%
Non-Pref Brand· after deductible
Tier 5
25%
Specialty· after deductible
Tier 6
$0
Tier 6· after deductible

Our take

Where this plan shines

See your primary doctor for $0.

Things to know before you enroll

This plan’s out-of-pocket maximum is above the national median.
Limited coverage while traveling outside the plan’s service area.
Questions? Talk to a licensed agent at1-866-764-3312 (TTY: 711)

Plan documents

Summary of Benefits (PDF)
Download the plan's official Summary of Benefits document
Evidence of Coverage (PDF)
Complete plan details and rules
Check Your Doctors
See if your doctors accept this plan
Documentos en español
Llame al (844)978-2770 (TTY: 711) para solicitar documentos en español

Helpful next steps

The Pocket Protector · NPN 21126942 · 1-866-764-3312 (TTY: 711) · thepocketprotector.com

Plan benefits, premiums, and copays may vary by county and plan. You must continue to pay your Medicare Part B premium. Benefits and costs may vary by service area. Contact the plan or CMS for complete details.

We do not offer every plan available in your area. Currently we represent a limited number of organizations which offer a limited number of products in your area. Please contact Medicare.gov, 1-800-MEDICARE (TTY: 1-877-486-2048), or your local State Health Insurance Program (SHIP) to get information on all of your options.

Members may receive a monthly or quarterly allowance in the form of a benefits prepaid card to pay for a wide range of plan-approved items. Unused amounts will expire at the end of the month or quarter.

Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you to contact the plan.

Dental, hearing, vision, and other supplemental benefits may have limitations and restrictions. These benefits vary by plan. Please refer to the plan's Evidence of Coverage for details.

The plan formulary, pharmacy network, and/or copays may change at any time. You will receive notice when necessary.

This spending allowance is a special supplemental program for members with specific health conditions. Qualifying conditions include diabetes mellitus, cardiovascular disorders, chronic and disabling mental health conditions, chronic lung disorders, or chronic heart failure, among others. Some plans may require at least two conditions and other requirements apply. See the plan's Evidence of Coverage for details.

Even if you have a listed chronic condition, you may not receive the benefit. Coverage also depends on the plan's specific coverage criteria for the SSBCI.

If you use this program for rent or utilities, Housing and Urban Development (HUD) requires it to be reported as income if you seek assistance. Contact your local HUD office if you have questions.

Benefits shown are based on CMS public plan data. Actual benefits vary by county. Not all plans available in all areas. Speak with a licensed agent before enrolling.

  1. The Pocket Protector represents Medicare Advantage HMO, PPO, and PFFS organizations and stand-alone PDP prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal.
  2. The Pocket Protector is not connected with or endorsed by the United States government or the federal Medicare program.

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DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP) - Devoted Health | The Pocket Protector