DEVOTED C-SNP CHOICE PLUS 013 IN (PPO C-SNP) H7471-013 • 2027 • Rush 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
- Rush County, IN
- Local Enrollment
- 0 beneficiaries in Rush 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 Rush County, Indiana. CMS reports 0 beneficiaries enrolled in this plan in Rush 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 Rush County
Compare this plan with the two most-enrolled PPO C-SNP plans available in Rush County, Indiana. Enrollment is based on CMS local enrollment data.
| Plan Detail | DEVOTED C-SNP CHOICE PLUS 013 IN | DEVOTED C-SNP CHOICE ENHANCED 014 IN | DEVOTED C-SNP CHOICE GIVEBACK EXTRAS 022 IN |
|---|---|---|---|
| CMS Plan ID | H7471-013-0 |
H7471-014-0 |
H7471-022-0 |
| Local Enrollment | 0 | 0 | 0 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $900 | $0.00 | $150 |
| Maximum Out-of-Pocket | $9,850.00 | $5,100.00 | $7,300.00 |
| Part B Giveback | Not offered | Not offered | −$110.00 reduction |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | 30% coinsurance | $40 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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