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Devoted CORE Greater Houston (HMO) H7993-001 Plan Details
4.5 out of 5 stars
Devoted CORE Greater Houston (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Devoted Health
Plan ID: H7993-001
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$0.00
Monthly Premium
Devoted CORE Greater Houston (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Devoted Health
Plan ID: H7993-001
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
Devoted CORE Greater Houston (HMO) H7993-001 Plan Details
4.5 out of 5 stars
Devoted CORE Greater Houston (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Devoted Health
Plan ID: H7993-001
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Get Medicare Help
$0.00
Monthly Premium
Texas Counties Served
Walker Orange Galveston Waller Hardin Liberty Chambers Montgomery Brazoria Harris Jefferson Fort Bend San Jacinto
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $0 |
Out of Pocket Max | In-Network: $3400 Out-of-Network: N/A |
Initial Coverage Limit | $5030 |
Catastrophic Coverage Limit | $8,000 |
Primary Care Doctor Visit | In-Network: Doctor Office Visit: |
Specialty Doctor Visit | In-Network: Doctor Specialty Visit: |
Inpatient Hospital Care | In-Network: Acute Hospital Services: |
Urgent Care | Copayment for Urgent Care $0.00 to $40.00 $0 urgently needed services in PCP office.$40 urgently needed services at urgent care center. Worldwide Coverage: |
Emergency Room Visit | Copayment for Emergency Care $135.00 Worldwide Coverage: |
Ambulance Transportation | In-Network: Ground Ambulance: Air Ambulance: Please see Evidence of Coverage for Prior Authorization rules |
Health Care Services and Medical Supplies
Devoted CORE Greater Houston (HMO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
Coverage | Cost |
---|---|
Chiropractic Services | In-Network: |
Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network: |
Durable Medical Eqipment (DME) | In-Network: |
Diagnostic Tests, Lab and Radiology Services, and X-Rays | In-Network: Outpatient Diag Procs/Tests/Lab Services: Outpatient Diag/Therapeutic Rad Services: |
Home Health Care | In-Network: |
Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: |
Mental Health Outpatient Care | In-Network: |
Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Outpatient Observation Services: Ambulatory Surgical Center Services: |
Outpatient Substance Abuse Care | In-Network: |
Over-the-counter (OTC) Items | In-Network: Over-The-Counter (OTC) Items: |
Podiatry Services | In-Network:
Referral Required for Podiatry Services |
Skilled Nursing Facility Care | In-Network: Skilled Nursing Facility Services: |
Dental Benefits
The following dental services are covered from in-network providers.
Coverage | Cost |
---|---|
Dental Care | In-Network: See the plan's Evidence of Coverage (EOC) for more details. Certain limitations apply. This is not an exhaustive list of covered dental services.
Copayment for Diagnostic Services $0.00
Copayment for Restorative Services $0.00
Copayment for Endodontics $0.00
Copayment for Periodontics $0.00
Copayment for Extractions $0.00
Copayment for Prosthodontics, Other Oral/Maxillofacial Surgery, Other Services $0.00
Maximum Plan Benefit of $4000.00 every year for Non-Medicare Covered Comprehensive |
Vision Benefits
The following vision services are covered from in-network providers.
Coverage | Cost |
---|---|
Vision Benefits | In-Network: Eye Exams:
Eyewear: |
Hearing Benefits
The following hearing services are covered from in-network providers.
Coverage | Cost |
---|---|
Hearing Benefits | In-Network: Hearing Exams:
Copayment for Fitting/Evaluation for Hearing Aid $0.00 Hearing Aids:
|
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
Coverage | Cost |
---|---|
Preventive Services and Health/Wellness Education Programs | In-Network: Abdominal aortic aneurysm screening
Tobacco use cessation |
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