DEVOTED CORE 001 NM (HMO) Medicare Advantage Plan H9977-001 • 2026 • Santa Fe County, NM

DEVOTED CORE 001 NM Overview

Plan Details for DEVOTED CORE 001 NM

With a monthly premium of $0.00, DEVOTED CORE 001 NM is a Medicare Advantage HMO plan that includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. Services are generally covered when received from in-network providers, except in emergency situations. The annual Part D deductible is $375.00.

Primary care visits have a $0 copay, specialist visits come with a $25 copay, urgent care services carry a $0-$45 copay, and ambulance transportation is $0-$350 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $4100.00. Once this limit is reached, in-network services are fully covered for the remainder of the year.

This plan is listed by CMS under Plan ID H9977-001. Cost-sharing details are provided below.

Out-of-Pocket Costs

Cost-sharing for DEVOTED CORE 001 NM includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H9977-001.

Certain preventive services are covered 100% by DEVOTED CORE 001 NM as a Part B benefit.

Prescription Drug Coverage

DEVOTED CORE 001 NM includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.

This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.

Prescription Drug Plan Premium

The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $375.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Devoted Health starts contributing towards your prescription costs.

Prescription Drug Plan Out-of-Pocket Costs

Beyond premiums and deductibles, DEVOTED CORE 001 NM may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Medicare Plan Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.