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

2026 Medicare plan code

H7355-004

Medicare Plan

DEVOTED DUAL CHOICE 004 MS (PPO D-SNP) · Devoted Health · Local PPO · Mississippi

Full CMS plan ID: H7355-004-000

H7355-004-000 is the full CMS identifier for the H7355-004 Medicare plan. Common searches include H7355 004 and H7355004.

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 DUAL CHOICE 004 MS (PPO D-SNP)

H7355-004-000 Mississippi Local PPO Dual-Eligible

At-a-glance

Quick view

01

In-network

Inpatient hospital

Days 1–9 $275 / day
Days 10–90 $0 / day
Total of listed copays · 9 charged days $2,475
02

Emergency transport

Ambulance

Ground · in-network$0–$315 copay
Air · in-network20% coinsurance
03

Emergency services

Emergency room

$130 copay

Waived if admitted within 24 hours

04

Medical maximum

Maximum out-of-pocket

In-network$5,400
Combined in + out$8,950
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$23.80 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

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

Specialist

In-network$35 copay
Out-of-network$35 copay

Preventive care

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

Diagnostic procedures & tests

In-network$0–$95 copay
Out-of-network$0–$95 copay

Laboratory services

In-network$0–$20 copay
Out-of-network$0–$20 copay

X-rays & standard imaging

In-network$0–$300 copay
Out-of-network$0–$300 copay

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$130 copay
Out-of-networkNot separately reported

Ground ambulance

In-network$0–$315 copay
Out-of-network$0–$315 copay

Air ambulance

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

Outpatient hospital

In-network$0–$375 copay
Out-of-network$0–$375 copay

Outpatient surgery / ASC

In-network$0–$275 copay
Out-of-network$0–$275 copay
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-network$35 copay
Out-of-network$35 copay

Occupational therapy

In-network$35–$50 copay
Out-of-network$35–$50 copay

Physical & speech therapy

In-network$35–$50 copay
Out-of-network$35–$50 copay
Behavioral health2 benefits

Mental health services

In-network$70 copay
Out-of-network$70 copay

Substance use treatment

In-network$70 copay
Out-of-network$70 copay
Specialty care2 benefits

Podiatry

In-network$35 copay
Out-of-network$35 copay

Chiropractic

In-network$15 copay
Out-of-network$15 copay
Supplemental benefits7 benefits

Dental

In-network$35 copay
Out-of-network$35 copay

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$5,400
Combined in + out$8,950

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

25% retail coinsurance · 30-day supply

Drug tier 2

25% retail coinsurance · 30-day supply

Drug tier 3

25% retail coinsurance · 30-day supply

Drug tier 4

25% 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 H7355-004-000

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 DUAL CHOICE 004 MS (PPO D-SNP) is a 2026 Local PPO offered by Devoted Health in Mississippi. 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 $2,475 across 9 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
$35 copay
Laboratory services
$0–$20 copay

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
$0–$95 copay
MRI, CT & PET imaging
20% coinsurance
Outpatient hospital
$0–$375 copay

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

Emergency & hospital care

Emergency room
$130 copay
Listed inpatient stages
$2,475 total

9 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
Mississippi (MS)
Plan type
Local PPO
Special Needs Plan
Dual-Eligible
Contract / plan
H7355-004
Coverage year
2026

This is a Dual-Eligible; 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.

Dental$35 copay
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 H7355-004-000 available?

DEVOTED DUAL CHOICE 004 MS (PPO D-SNP) is listed for Mississippi (MS). This is a Dual-Eligible; 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 H7355-004-000?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $5,400. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H7355-004-000?

The listed consolidated Part C and Part D premium is $23.80 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H7355-004-000?

The plan record lists $130 copay, waived when an admission meets the plan's stated timing rule.

Does H7355-004-000 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 H7355-004-000 fits

Full CMS plan ID
H7355-004-000
Contract
H7355
Base plan code
H7355-004
Segment
000
Carrier
Devoted Health
Plan type
Local PPO
Service area
Mississippi (MS)

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.

  • Benton, MS
  • Copiah, MS
  • DeSoto, MS
  • Greene, MS
  • Hancock, MS
  • Harrison, MS
  • Hinds, MS
  • Holmes, MS
  • Issaquena, MS
  • Leake, MS
  • Madison, MS
  • Marshall, MS

12 additional service-area entries are retained in the data record.

Same CMS contract

H7355-001-000 DEVOTED CHOICE 001 MS (PPO) Mississippi · Local PPO H7355-002-000 DEVOTED CHOICE GIVEBACK 002 MS (PPO) Mississippi · Local PPO H7355-003-000 DEVOTED DUAL CHOICE PLUS 003 MS (PPO D-SNP) Mississippi · Local PPO H7355-006-000 DEVOTED C-SNP CHOICE 006 MS (PPO C-SNP) Mississippi · Local PPO H7355-007-000 DEVOTED C-SNP CHOICE PREMIUM 007 MS (PPO C-SNP) Mississippi · Local PPO H7355-009-000 DEVOTED DUAL CHOICE FULL 009 MS (PPO D-SNP) Mississippi · Local PPO H7355-010-000 DEVOTED C-SNP CHOICE PLUS 010 MS (PPO C-SNP) Mississippi · Local PPO

About this code

What H7355-004-000 identifies

H7355-004-000 is a Contract Year 2026 Medicare plan segment code. Searches written as H7355-004, H7355 004, or the compact full CMS ID H7355004000 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.