DEVOTED C-SNP CHOICE PREMIUM 015 GA (PPO C-SNP)
Available to residents of Fayette County, GA for 2026. Contract H5453, plan 015, segment 0.
Plan details
| Monthly drug premium | $25.40 |
|---|---|
| Drug deductible | $615.00Tier 6 exempt |
| Plan type | Chronic-condition SNP |
| Special needs plan | Chronic-condition SNP |
| Contract / plan | H5453-015-0 |
| Offered by | Devoted Health |
| Parent organization | Devoted Health, Inc. |
| Formulary drugs | 3,377 |
CMS star ratings
- Overall
- —
- Health plan (Part C)
- —
- Drug plan (Part D)
- —
Published per contract — every plan under contract H5453 shares this rating.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $18.00 |
| Tier 2 | $19.00 |
| Tier 3 | 21% |
| Tier 4 | 33% |
| Tier 5 | 25% |
| Tier 6 | $0.00 |
Also available in 15 other GA counties
Plan facts come from the CMS quarterly prescription drug plan public use files.