In-network
Inpatient hospital
Per admission $1,941 per stay
Out-of-network
Tier 1: 40% coinsurance
Point of service
Not separately reported
● CMS 2027 plan record
DEVOTED C-SNP CHOICE PLUS 003 DE (PPO C-SNP)
Choose and order benefitsSelections are saved only on this device.
Emergency transport
Ambulance
Ground · in-network50% coinsurance
Air · in-network50% coinsurance
Emergency services
Emergency room
$115 copay
Waived if admitted within 24 hours
Medical maximum
Maximum out-of-pocket
In-network$9,850
Combined in + out$14,800
Skilled care at home
Home health
In-network$0 cost share
Out-of-network$0 cost share
Monthly cost
Premium & giveback
Part C premium$0 / month
Consolidated C + D$0 / month
CMS reports no Part B premium reduction for this plan.
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Primary care physician
In: Primary Care Physician Services: $0 cost share · Out: 7a: 30% coinsurance
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Specialist
In: Physician Specialist Services: 30% coinsurance · Out: 7d: 40% coinsurance
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Preventive care
In: Annual Physical Exam: $0 cost share; Kidney Disease Education Services: $0 cost share; Glaucoma Screening: $0 cost share; Diabetes Self-Management Training: $0 cost share; Digital Rectal Exams: $0 cost share; EKG following Welcome Visit: $0 cost share · Out: 14b: $0 cost share; 14d: $0 cost share; 14e1: $0 cost share; 14e2: $0 cost share; 14e4: $0 cost share; 14e5: $0 cost share; 14a: $0 cost share
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Diagnostic procedures & tests
In: Diagnostic Procedures/Tests: 0%–50% coinsurance · Out: 8a1: 0%–50% coinsurance
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Laboratory services
In: Lab Services: 0%–50% coinsurance · Out: 8a2: 0%–50% coinsurance
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X-rays & standard imaging
In: Outpatient X-Ray Services: 40% coinsurance · Out: 8b3: 40% coinsurance
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MRI, CT & PET imaging
In: Diagnostic Radiological Services: 40%–50% coinsurance · Out: 8b1: 40%–50% coinsurance
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Urgent care
In: Urgently Needed Services: 0%–20% coinsurance · Out: Not separately reported
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Emergency room
In: $115 copay · Out: Not separately reported
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Ground ambulance
In: 50% coinsurance · Out: 50% coinsurance
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Air ambulance
In: 50% coinsurance · Out: 50% coinsurance
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Outpatient hospital
In: Outpatient Hospital Services: 15%–50% coinsurance; Observation Services: 50% coinsurance · Out: 9a1: 15%–50% coinsurance; 9a2: 50% coinsurance
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Outpatient surgery / ASC
In: Ambulatory Surgical Center (ASC) Services: 15%–50% coinsurance · Out: 9b: 15%–50% coinsurance
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Home health
In: $0 cost share · Out: $0 cost share
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Skilled nursing facility
In: Skilled nursing facility: Tier 1: $0 / day for days 1–20; $221 / day for days 21–100 · Out: Skilled nursing facility: Tier 1: 40% coinsurance
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Cardiac & pulmonary rehabilitation
In: Cardiac Rehabilitation Services: 30% coinsurance; Intensive Cardiac Rehabilitation Services: 30% coinsurance; Pulmonary Rehabilitation Services: 30% coinsurance; SET for PAD Services: 30% coinsurance; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable · Out: 3-1: 30% coinsurance; 3-2: 30% coinsurance; 3-3: 30% coinsurance; 3-4: 30% coinsurance
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Occupational therapy
In: Occupational Therapy Services: 30% coinsurance · Out: 7c: 30% coinsurance
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Physical & speech therapy
In: Physical Therapy and Speech-Language Pathology Services: 30% coinsurance · Out: 7i: 40% coinsurance
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Mental health services
In: Partial Hospitalization Program: 20% coinsurance; Individual Sessions for Mental Health Specialty Services: 30% coinsurance; Group Sessions for Mental Health Specialty Services: 30% coinsurance; Individual Sessions for Psychiatric Services: 30% coinsurance; Group Sessions for Psychiatric Services: 30% coinsurance; Inpatient psychiatric hospital: Tier 1: $1,791 per stay · Out: 5a: 20% coinsurance; 7e1: 30% coinsurance; 7e2: 30% coinsurance; 7h1: 30% coinsurance; 7h2: 30% coinsurance; Inpatient psychiatric hospital: Tier 1: 40% coinsurance
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Substance use treatment
In: Intensive Outpatient Program Services: 20% coinsurance; Individual Sessions for Outpatient Substance Abuse: 30% coinsurance; Group Sessions for Outpatient Substance Abuse: 30% coinsurance · Out: 5b: 20% coinsurance; 9c1: 30% coinsurance; 9c2: 30% coinsurance
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Podiatry
In: Podiatry Services: 30% coinsurance · Out: 7f: 40% coinsurance; 7f_2: $0 cost share
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Chiropractic
In: Chiropractic Services: 30% coinsurance · Out: 7b: 30% coinsurance
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Dental
In: Medicare Dental Services: 30% coinsurance; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 cost share; Dental X-Rays: $0 cost share; Prophylaxis (Cleaning): $0 cost share; Fluoride Treatment: $0 cost share; Restorative Services: $0 cost share; Endodontics: $0 cost share; Periodontics: $0 cost share; Prosthodontics, removable: $0 cost share; Implant Services: $0 cost share; Prosthodontics, fixed: $0 cost share; Oral and Maxillofacial Surgery: $0 cost share; Adjunctive General Services: $0 cost share · Out: 16a: 40% coinsurance; 16b1: $0 cost share; 16b2: $0 cost share; 16b4: $0 cost share; 16b5: $0 cost share; 16c1: $0 cost share; 16c2: $0 cost share; 16c3: $0 cost share; 16c4: $0 cost share; 16c6: $0 cost share; 16c7: $0 cost share; 16c8: $0 cost share; 16c10: $0 cost share
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Vision
In: Eye Exams: 0%–50% coinsurance; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: $0 cost share; Eyeglasses (lenses and frames): $0 cost share; Eyeglass lenses: $0 cost share; Eyeglass frames: $0 cost share; Upgrades: $0 cost share · Out: 17a: 0%–50% coinsurance; 17a1: $0 cost share; 17b: $0 cost share; 17b1: $0 cost share; 17b2: $0 cost share; 17b3: $0 cost share; 17b4: $0 cost share; 17b5: $0 cost share
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Hearing
In: Hearing Exams: 50% coinsurance; Prescription Hearing Aids (all types): $399–$699 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable · Out: 18a: 50% coinsurance; 18a1: $35 copay; 18a2: $35 copay; 18b1: 90% coinsurance
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Transportation
In: 10b(NMC): Not applicable · Out: Not separately reported
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Fitness & wellness
In: Fitness Benefit: $0 cost share · Out: 14c4: 0%–90% coinsurance
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Over-the-counter allowance
In: Over-the-Counter (OTC) Items: $0 cost share · Out: 13b: 90% coinsurance
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Meals
In: Meal Benefit: Not applicable · Out: Not separately reported
Plan details
All plan benefits
No benefits match that search.
Medical care3 benefits
Primary care physician
In-networkPrimary Care Physician Services: $0 cost share
Out-of-network7a: 30% coinsurance
Specialist
In-networkPhysician Specialist Services: 30% coinsurance
Out-of-network7d: 40% coinsurance
Preventive care
In-networkAnnual Physical Exam: $0 cost share; Kidney Disease Education Services: $0 cost share; Glaucoma Screening: $0 cost share; Diabetes Self-Management Training: $0 cost share; Digital Rectal Exams: $0 cost share; EKG following Welcome Visit: $0 cost share
Out-of-network14b: $0 cost share; 14d: $0 cost share; 14e1: $0 cost share; 14e2: $0 cost share; 14e4: $0 cost share; 14e5: $0 cost share; 14a: $0 cost share
Diagnostics & imaging4 benefits
Diagnostic procedures & tests
In-networkDiagnostic Procedures/Tests: 0%–50% coinsurance
Out-of-network8a1: 0%–50% coinsurance
Laboratory services
In-networkLab Services: 0%–50% coinsurance
Out-of-network8a2: 0%–50% coinsurance
X-rays & standard imaging
In-networkOutpatient X-Ray Services: 40% coinsurance
Out-of-network8b3: 40% coinsurance
MRI, CT & PET imaging
In-networkDiagnostic Radiological Services: 40%–50% coinsurance
Out-of-network8b1: 40%–50% coinsurance
Urgent & hospital care6 benefits
Urgent care
In-networkUrgently Needed Services: 0%–20% coinsurance
Out-of-networkNot separately reported
Emergency room
In-network$115 copay
Out-of-networkNot separately reported
Ground ambulance
In-network50% coinsurance
Out-of-network50% coinsurance
Air ambulance
In-network50% coinsurance
Out-of-network50% coinsurance
Outpatient hospital
In-networkOutpatient Hospital Services: 15%–50% coinsurance; Observation Services: 50% coinsurance
Out-of-network9a1: 15%–50% coinsurance; 9a2: 50% coinsurance
Outpatient surgery / ASC
In-networkAmbulatory Surgical Center (ASC) Services: 15%–50% coinsurance
Out-of-network9b: 15%–50% coinsurance
Recovery & therapy5 benefits
Home health
In-network$0 cost share
Out-of-network$0 cost share
Skilled nursing facility
In-networkSkilled nursing facility: Tier 1: $0 / day for days 1–20; $221 / day for days 21–100
Out-of-networkSkilled nursing facility: Tier 1: 40% coinsurance
Cardiac & pulmonary rehabilitation
In-networkCardiac Rehabilitation Services: 30% coinsurance; Intensive Cardiac Rehabilitation Services: 30% coinsurance; Pulmonary Rehabilitation Services: 30% coinsurance; SET for PAD Services: 30% coinsurance; 3-1(NMC): Not applicable; 3-2(NMC): Not applicable; 3-3(NMC): Not applicable; 3-4(NMC): Not applicable
Out-of-network3-1: 30% coinsurance; 3-2: 30% coinsurance; 3-3: 30% coinsurance; 3-4: 30% coinsurance
Occupational therapy
In-networkOccupational Therapy Services: 30% coinsurance
Out-of-network7c: 30% coinsurance
Physical & speech therapy
In-networkPhysical Therapy and Speech-Language Pathology Services: 30% coinsurance
Out-of-network7i: 40% coinsurance
Behavioral health2 benefits
Mental health services
In-networkPartial Hospitalization Program: 20% coinsurance; Individual Sessions for Mental Health Specialty Services: 30% coinsurance; Group Sessions for Mental Health Specialty Services: 30% coinsurance; Individual Sessions for Psychiatric Services: 30% coinsurance; Group Sessions for Psychiatric Services: 30% coinsurance; Inpatient psychiatric hospital: Tier 1: $1,791 per stay
Out-of-network5a: 20% coinsurance; 7e1: 30% coinsurance; 7e2: 30% coinsurance; 7h1: 30% coinsurance; 7h2: 30% coinsurance; Inpatient psychiatric hospital: Tier 1: 40% coinsurance
Substance use treatment
In-networkIntensive Outpatient Program Services: 20% coinsurance; Individual Sessions for Outpatient Substance Abuse: 30% coinsurance; Group Sessions for Outpatient Substance Abuse: 30% coinsurance
Out-of-network5b: 20% coinsurance; 9c1: 30% coinsurance; 9c2: 30% coinsurance
Specialty care2 benefits
Podiatry
In-networkPodiatry Services: 30% coinsurance
Out-of-network7f: 40% coinsurance; 7f_2: $0 cost share
Chiropractic
In-networkChiropractic Services: 30% coinsurance
Out-of-network7b: 30% coinsurance
Supplemental benefits7 benefits
Dental
In-networkMedicare Dental Services: 30% coinsurance; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 cost share; Dental X-Rays: $0 cost share; Prophylaxis (Cleaning): $0 cost share; Fluoride Treatment: $0 cost share; Restorative Services: $0 cost share; Endodontics: $0 cost share; Periodontics: $0 cost share; Prosthodontics, removable: $0 cost share; Implant Services: $0 cost share; Prosthodontics, fixed: $0 cost share; Oral and Maxillofacial Surgery: $0 cost share; Adjunctive General Services: $0 cost share
Out-of-network16a: 40% coinsurance; 16b1: $0 cost share; 16b2: $0 cost share; 16b4: $0 cost share; 16b5: $0 cost share; 16c1: $0 cost share; 16c2: $0 cost share; 16c3: $0 cost share; 16c4: $0 cost share; 16c6: $0 cost share; 16c7: $0 cost share; 16c8: $0 cost share; 16c10: $0 cost share
Vision
In-networkEye Exams: 0%–50% coinsurance; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: $0 cost share; Eyeglasses (lenses and frames): $0 cost share; Eyeglass lenses: $0 cost share; Eyeglass frames: $0 cost share; Upgrades: $0 cost share
Out-of-network17a: 0%–50% coinsurance; 17a1: $0 cost share; 17b: $0 cost share; 17b1: $0 cost share; 17b2: $0 cost share; 17b3: $0 cost share; 17b4: $0 cost share; 17b5: $0 cost share
Hearing
In-networkHearing Exams: 50% coinsurance; Prescription Hearing Aids (all types): $399–$699 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Out-of-network18a: 50% coinsurance; 18a1: $35 copay; 18a2: $35 copay; 18b1: 90% coinsurance
Transportation
Not applicableIn-network10b(NMC): Not applicable
Out-of-networkNot separately reported
Fitness & wellness
In-networkFitness Benefit: $0 cost share
Out-of-network14c4: 0%–90% coinsurance
Over-the-counter allowance
In-networkOver-the-Counter (OTC) Items: $0 cost share
Out-of-network13b: 90% coinsurance
Meals
Not applicableIn-networkMeal Benefit: Not applicable
Out-of-networkNot separately reported
Plan costs & rulesCoverage overview
Premium & Part B giveback
$0 Part C premium / month · CMS reports no Part B premium reduction for this plan.
Maximum out-of-pocket (MOOP)
In-network$9,850
Combined in + out$14,800
Medical deductibles
In-networkNot reported
Out-of-networkNot reported
Annual health deductible
$990
Combined network deductible
Not separately reported
Part D premium
$0 / month
Network & referrals
Local PPO · Referrals: Not required · Out-of-network coverage: Yes
Prescription drugs5 tiers
Part D deductible
$461 / year
Drug tier 1
Standard retail: $0 copay · Preferred retail: $0 copay · 30-day supply
Drug tier 2
Standard retail: $0 copay · Preferred retail: $0 copay · 30-day supply
Drug tier 3
Standard retail: 15% coinsurance · Preferred retail: 15% coinsurance · 30-day supply
Drug tier 4
Standard retail: 25% coinsurance · Preferred retail: 25% coinsurance · 30-day supply
Drug tier 5
Standard retail: 26% coinsurance · Preferred retail: 26% coinsurance · 30-day supply
Using this plan
Understand H0413-003-000
Plain-language context built from this plan’s 2027 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 2027 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.
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
- Primary Care Physician Services: $0 cost share
- Specialist
- Physician Specialist Services: 30% coinsurance
- Laboratory services
- Lab Services: 0%–50% coinsurance
Separate visits or services; costs are not added together.
Tests & outpatient care
- Diagnostic procedures & tests
- Diagnostic Procedures/Tests: 0%–50% coinsurance
- MRI, CT & PET imaging
- Diagnostic Radiological Services: 40%–50% coinsurance
- Outpatient hospital
- Outpatient Hospital Services: 15%–50% coinsurance; Observation Services: 50% coinsurance
The service setting and billing details can change what you pay.
Emergency & hospital care
- Emergency room
- $115 copay
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.
Part B premium reduction (“giveback”)
A giveback may reduce the amount you pay toward Medicare Part B; it is not usually paid to you as cash. The CMS record notes: CMS reports no Part B premium reduction for this plan.
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
- 2027
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.
DentalMedicare Dental Services: 30% coinsurance; Diagnostic and Preventive Dental: $0 cost share; Oral Exams: $0 cost share; Dental X-Rays: $0 cost share; Prophylaxis (Cleaning): $0 cost share; Fluoride Treatment: $0 cost share; Restorative Services: $0 cost share; Endodontics: $0 cost share; Periodontics: $0 cost share; Prosthodontics, removable: $0 cost share; Implant Services: $0 cost share; Prosthodontics, fixed: $0 cost share; Oral and Maxillofacial Surgery: $0 cost share; Adjunctive General Services: $0 cost share
VisionEye Exams: 0%–50% coinsurance; Other Eye Exam Services: Not applicable; Eyewear: $0 cost share; Contact Lenses: $0 cost share; Eyeglasses (lenses and frames): $0 cost share; Eyeglass lenses: $0 cost share; Eyeglass frames: $0 cost share; Upgrades: $0 cost share
HearingHearing Exams: 50% coinsurance; Prescription Hearing Aids (all types): $399–$699 copay; Prescription Hearing Aids - Inner Ear: Not applicable; Prescription Hearing Aids - Outer Ear: Not applicable; Prescription Hearing Aids - Over the Ear: Not applicable
Over-the-counter allowanceOver-the-Counter (OTC) Items: $0 cost share
Fitness & wellnessFitness Benefit: $0 cost share
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 2027 CMS record lists an in-network medical maximum out-of-pocket limit of $9,850. 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 $0 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, over-the-counter allowance, fitness & wellness. See the detailed benefit rows and official plan documents for limits and conditions.
Source trail
Official CMS, Contract Year 2027
Plan identity and benefits come from CMS PBP data. Benefits and drug cost sharing come from the approved annual PBP tabular extract and its CMS dictionary. Premiums and drug deductibles are cross-checked with the annual Landscape. Geography comes from annual PlanArea and PlanRegionArea records, including exact segments and partial-county or employer/group qualifiers. Quick-reference values should be confirmed in current official plan documents.
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
Service areas come from the annual CMS PlanArea and PlanRegionArea tables for this exact contract, plan, and segment. Partial-county and employer/group qualifiers remain part of the coverage area. Regional PPO county entries use the matching annual Landscape expansion of the CMS region.
- New Castle, DE
Exact county navigation
Counties with exact segment geography
These links are limited to named counties tied to this exact medical plan segment. Partial-county entries remain labeled for verification.
Show 1 county link
Delaware
About this code
What H0413-003-000 identifies
H0413-003-000 is a Contract Year 2027 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.