Special Needs Plan (Medicare Advantage) · PPO D-SNP · Plan ID H4473-004
DEVOTED DUAL CHOICE FULL 004 UT (PPO D-SNP)
Offered by Devoted Health (Devoted Health, Inc.) · available in 11 counties in UT
Only for people who have both Medicare and Medicaid.
Monthly premium$0health + drug coverage
Yearly out-of-pocket max$9,850in network
Drug deductible$700Enhanced Alternative
Star RatingPlan Too New To Be Measured2027 CMS rating
Extra benefits listed in the CMS file
| Dental | Preventive and comprehensive dental |
|---|---|
| Vision | routine eye exam; eyewear |
| Hearing | routine hearing exam; hearing aids |
| Over-the-counter items | $50 per quarter allowance |
| Fitness | Fitness benefit (gym membership or program) |
| Home safety | Home and bathroom safety devices or modifications |
Allowances and limits come from the plan's filing with CMS and are simplified here. Some benefits are only for members with certain chronic conditions. The plan's Evidence of Coverage is the final word.
Check the details that matter most
- Is my doctor in the network? (plan's provider directory)
- Are my prescriptions covered? (plan's drug list)
- Is my pharmacy in the network?
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- See this plan on Medicare.gov, where you can add your prescriptions and compare estimated yearly costs.
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