DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) H7471-013 • 2027 • Elkhart County, IN
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $900
- Maximum Out-of-Pocket
- $9850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $461.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Elkhart County, IN
- Local Enrollment
- 88 beneficiaries in Elkhart County
Introduction
CMS Plan ID H7471-013 identifies DEVOTED C-SNP CHOICE PLUS 013 IN, a Medicare Advantage Chronic Condition Special Needs Plan (C-SNP) offered by Devoted Health. Its provider network is a Preferred Provider Organization (PPO), and Medicare Part D prescription drug coverage is included. For 2027, the plan has a $0.00 monthly premium, $900 medical deductible, and $9850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $461.00.
Enrollment in this plan requires you to live in Elkhart County, Indiana. CMS reports 88 beneficiaries enrolled in this plan in Elkhart County. New members can call the plan directly at (844)978-2770 (TTY 711) for assistance.
Eligibility
DEVOTED C-SNP CHOICE PLUS 013 IN is a Chronic Condition Special Needs Plan (C-SNP) designed for people with qualifying health conditions.
- Special Needs Plan Type
- Chronic Condition Special Needs Plan (C-SNP)
- Medicare Requirement
- Must have Medicare Part A and Part B
- Special Needs Requirement
- This plan is for individuals with cardiovascular disorders, chronic heart failure, and/or diabetes mellitus.
- Service Area Requirement
- Must live in the plan's service area
- Prescription Drug Coverage
- Medicare Part D prescription drug coverage is included.
Compare Similar Plans in Elkhart County
Compare this plan with the two most-enrolled PPO C-SNP plans available in Elkhart County, Indiana. Enrollment is based on CMS local enrollment data.
| Plan Detail | DEVOTED C-SNP CHOICE PLUS 013 IN | DEVOTED C-SNP CHOICE ENHANCED 016 IN | DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 020 IN |
|---|---|---|---|
| CMS Plan ID | H7471-013-0 |
H7471-016-0 |
H7471-020-0 |
| Local Enrollment | 88 | 63 | 0 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $900 | $0.00 | $150 |
| Maximum Out-of-Pocket | $9,850.00 | $6,200.00 | $7,350.00 |
| Part B Giveback | Not offered | Not offered | −$110.00 reduction |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | 30% coinsurance | $50 copay | $50 copay |
| Part D Deductible | $461.00 | $461.00 | $700.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
DEVOTED C-SNP CHOICE PLUS 013 IN has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H7471-013.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H7471-013-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: 30% coinsurance - Specialist
- In-network: 30% coinsurance
Out-of-network: 40% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Telehealth benefit
- In-network: 0%-30% coinsurance
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
Out-of-network: 90% coinsurance - Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: 40%-50% coinsurance
Out-of-network: 40%-50% coinsurance - Lab services
- In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance - Outpatient x-rays
- In-network: 40% coinsurance
Out-of-network: 40% coinsurance - Diagnostic tests and procedures
- In-network: 0%-50% coinsurance
Out-of-network: 0%-50% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $115 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- 0%-20% coinsurance
- Inpatient hospital care
- In-network:
Tier 1
$2,241 per stay
Out-of-network:
40% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
40% per stay - Ground ambulance
- In-network: 50% coinsurance
Out-of-network: 50% coinsurance
Mental Health Services
- Outpatient individual therapy
- In-network: 30% coinsurance
Out-of-network: 30% coinsurance - Outpatient group therapy
- In-network: 30% coinsurance
Out-of-network: 30% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$2,241 per stay
Out-of-network:
40% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: 30% coinsurance
Out-of-network: 40% coinsurance - Occupational therapy
- In-network: 30% coinsurance
Out-of-network: 30% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 0%-50% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Periodontics
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Endodontics
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Restorative services
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Implant services
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Contact lenses
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglass frames only
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglass lenses only
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Eyeglasses (frames & lenses)
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Upgrades
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: $35 copay - Fitting/evaluation
- In-network: $0 copay
Out-of-network: $35 copay - Prescription hearing aids
- In-network: $399-$699 copay
Out-of-network: 90% coinsurance - OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Massage therapy
- Not covered
- Home/bathroom safety devices
- In-network: $0 copay
Out-of-network: 50% coinsurance
Certain preventive services are covered 100% by DEVOTED C-SNP CHOICE PLUS 013 IN as a Part B benefit.
Prescription Drug Coverage
DEVOTED C-SNP CHOICE PLUS 013 IN 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.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage 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.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($60.80) |
| Supplemental Part D Premium: | $60.80 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $17.02 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $461.00 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 C-SNP CHOICE PLUS 013 IN may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | $18.00 copay |
| Generic | $0.00 copay | $19.00 copay |
| Preferred Brand | 15% coinsurance | 25% coinsurance |
| Non-Preferred Drug | 25% coinsurance | 31% coinsurance |
| Specialty Tier | 26% coinsurance | 25% coinsurance |
| Select Care Drugs | Not available | $0.00 copay |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H7471)
Medicare evaluates plan quality using a star rating system developed by the Centers for Medicare & Medicaid Services (CMS). Ratings are based on measures such as health outcomes, member experience, and customer service, and are reported on a 1 to 5 star scale, with higher ratings indicating stronger overall performance.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing | Plan too new to be measured |
Contact Information for Devoted Health
- Website
- Devoted Health Plan Page
- Providers
- Devoted Health Providers Page
- Formulary
- Devoted Health Formulary Page
- Pharmacy
- Devoted Health Pharmacy Page
- New Member Health Plan Help
- (844)978-2770
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (844)978-2770
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Devoted Health (official source) | http://www.devoted.com | October 4, 2026 |
| CMS.gov | Chronic Condition Special Needs Plans (C-SNPs) | April 28, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | April 28, 2026 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | April 28, 2026 |
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