Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H0413-003

Medicare Plan

DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP) · Devoted Health · Local PPO · Delaware

Full CMS plan ID: H0413-003-000

H0413-003-000 is the full CMS identifier for the H0413-003 Medicare plan. Common searches include H0413 003 and H0413003.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

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

H0413-003-000 Delaware Local PPO Chronic or Disabling Condition

At-a-glance

Quick view

01

In-network

Inpatient hospital

Per admission $2,230 per stay
Plan-listed inpatient copay $2,230
02

Emergency transport

Ambulance

Ground · in-network0%–50% coinsurance
Air · in-network50% coinsurance
03

Emergency services

Emergency room

$115 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$9,250
Combined in + out$13,900
05

Skilled care at home

Home health

In-networkCost share not reported
Out-of-networkCost share not reported
06

Monthly cost

Premium & giveback

Part C premium$0 / month
Consolidated C + D$31.20 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

In-networkCost share not reported
Out-of-network40% coinsurance

Specialist

In-network30% coinsurance
Out-of-network40% coinsurance

Preventive care

In-networkCost share not reported
Out-of-networkCost share not reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

In-network0%–50% coinsurance
Out-of-network0%–50% coinsurance

Laboratory services

In-network50% coinsurance
Out-of-network50% coinsurance

X-rays & standard imaging

In-network50% coinsurance
Out-of-network50% coinsurance

MRI, CT & PET imaging

In-network20% coinsurance
Out-of-network20% coinsurance
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$115 copay
Out-of-networkNot separately reported

Ground ambulance

In-network0%–50% coinsurance
Out-of-network0%–50% coinsurance

Air ambulance

In-network50% coinsurance
Out-of-network50% coinsurance

Outpatient hospital

In-network0%–50% coinsurance
Out-of-network0%–50% coinsurance

Outpatient surgery / ASC

In-network0%–50% coinsurance
Out-of-network0%–50% coinsurance
Recovery & therapy5 benefits

Home health

In-networkCost share not reported
Out-of-networkCost share not reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

In-network30% coinsurance
Out-of-network40% coinsurance

Occupational therapy

In-network30% coinsurance
Out-of-network40% coinsurance

Physical & speech therapy

In-network30% coinsurance
Out-of-network40% coinsurance
Behavioral health2 benefits

Mental health services

In-network20% coinsurance
Out-of-network20% coinsurance

Substance use treatment

In-network20% coinsurance
Out-of-network20% coinsurance
Specialty care2 benefits

Podiatry

In-networkCost share not reported
Out-of-networkCost share not reported

Chiropractic

In-network$15 copay
Out-of-network40% coinsurance
Supplemental benefits7 benefits

Dental

In-network30% coinsurance
Out-of-network40% coinsurance

Vision

In-networkCost share not reported
Out-of-networkCost share not reported

Hearing

In-network$399–$699 copay
Out-of-network$399–$699 copay

Transportation

Not reported in this CMS export

Not reported in this CMS export

Fitness & wellness

In-networkCost share not reported
Out-of-networkCost share not reported

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

In-networkCost share not reported
Out-of-networkCost share not reported
Plan costs & rulesCoverage overview

Premium & Part B giveback

$0 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$9,250
Combined in + out$13,900

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

Local PPO · Referrals: Not required · Out-of-network coverage: Yes

Prescription drugs6 tiers

Part D deductible

Not reported

Drug tier 1

$18 retail copay · 30-day supply

Drug tier 2

$19 retail copay · 30-day supply

Drug tier 3

25% retail coinsurance · 30-day supply

Drug tier 4

31% retail coinsurance · 30-day supply

Drug tier 5

25% retail coinsurance · 30-day supply

Drug tier 6

$0 retail copay · 30-day supply

Using this plan

Understand H0413-003-000

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP) is a 2026 Local PPO offered by Devoted Health in Delaware. The CMS record indicates out-of-network coverage, although member costs may differ from in-network care. The plan record does not require referrals. Its listed inpatient copay stages total $2,230 across null charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Cost share not reported
Specialist
30% coinsurance
Laboratory services
50% coinsurance

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
0%–50% coinsurance
MRI, CT & PET imaging
20% coinsurance
Outpatient hospital
0%–50% coinsurance

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$115 copay
Listed inpatient stages
$2,230 total

null charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Delaware (DE)
Plan type
Local PPO
Special Needs Plan
Chronic or Disabling Condition
Contract / plan
H0413-003
Coverage year
2026

This is a Chronic or Disabling Condition; enrollment requires the plan's specific eligibility criteria as well as residence in its service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental30% coinsurance
VisionCost share not reported
Hearing$399–$699 copay
Fitness & wellnessCost share not reported
MealsCost share not reported

Plan-specific answers

Frequently asked questions

Where is H0413-003-000 available?

DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP) is listed for Delaware (DE). This is a Chronic or Disabling Condition; enrollment requires the plan's specific eligibility criteria as well as residence in its service area.

What is the in-network maximum out-of-pocket limit for H0413-003-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $9,250. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H0413-003-000?

The listed consolidated Part C and Part D premium is $31.20 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H0413-003-000?

The plan record lists $115 copay, waived when an admission meets the plan's stated timing rule.

Does H0413-003-000 report extra benefits?

Yes. CMS reports dental, vision, hearing, fitness & wellness, meals. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H0413-003-000 fits

Full CMS plan ID
H0413-003-000
Contract
H0413
Base plan code
H0413-003
Segment
000
Carrier
Devoted Health
Plan type
Local PPO
Service area
Delaware (DE)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • New Castle, DE

Same CMS contract

H0413-001-000 DEVOTED CHOICE 001 DE (PPO) Delaware · Local PPO H0413-002-000 DEVOTED CHOICE GIVEBACK 002 DE (PPO) Delaware · Local PPO

About this code

What H0413-003-000 identifies

H0413-003-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H0413-003, H0413 003, or the compact full CMS ID H0413003000 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.